How did you hear of the ministry? FriendNewspaperTVMailing ReferralWebsite Program Interest (Choose One) Adult Children's Please select classes you would like to register for: Ballet1 Ballet2 Modern/Jazz1 Modern/Jazz2 African Dance *Choreography Tap Dance Swing Dance Liturgical Dance Flags/Banners1 *Flags/Banners2 Streamers Tambourine1 Tambourine2 *Theatre Dance Acting *Musical Theatre *Voice For Actor Play Writing Production Nutrition Aerobics ****Classes that have an asterisk are taken with another class Musical Theatre must be taken with Acting Theater Dance must be taken with Acting Flags Level 2 must get permission from Director Choreography must get permission from Director   Student Information: Student's First Name:  * Last Name:  * Birthdate:  * Student's Gender: MaleFemale Email Address:  * Address:  * City:  * State:  * Zip Code:  * Home Phone:  * Cell Phone: Work Number: Health Insurance Carrier:  * School: Disabilities:  * Allergies:  * Medications:  * Primary Doctor:  * Dr.'s Phone Number:  * Emergency Contact: Name: Address: Phone: Relationship: Security code:   * Do not enter anything in this field:

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