Thank you for your interest in our program!

As soon as we receive your information, we will follow up with you via email.
Please include a student email address that you check regularly.

Student Name

First Name

Last Name

Current Grade Level of Student

9th

10th

11th

12th

Middle School

Current School

District Student Number

Student Cell Phone Number

(###)

###

####

Student Contact Email

Guardian 1 Name

First Name

Last Name

Guardian 1 Relation

Guardian 1 Cell Phone Number

(###)

###

####

Guardian 1 Email

Guardian 2 Name

First Name

Last Name

Guardian 2 Relation

Guardian 2 Cell Phone Number

(###)

###

####

Guardian 2 Email

In the next school year, what other clubs and activities will you participate in (on campus or off)?

List any previous dance / gymnastics / sports experience.

Please list any conditions you think we need to be aware of.

What makes you want to be a part of our team?

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