New Student Mommy Fit — Creative Dance Center

NEW STUDENT MOMMY FIT

Name

First Name

Last Name

Birthday

Home Address

Phone

(###)

###

####

Email

Do you have any current injuries, health restrictions/limitations, or allergies?

Emergency Contact

First Name

Last Name

Relationship

Emergency Contact Phone

(###)

###

####

Will any children be coming to the class with you?

Child's Name & Birthday