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Praise Registration (Student) Form

Fill out this form to register as a student of Praise Academy of Dance.

First name ■

First name of Registrant

Last name ■

Last name of registrant

Email Address ■

An email address that can be used to communicate with the registrant, or the registrant's parent or guardian.

Date of Birth

Enter the date of birth in the format year/month/day (e.g. 1989/03/30)

/ /

Marital Status ■

Please indicate the marital status of the registrant.

Home Address ■

Home Phone

Cell Phone

Contact Person in case of Emergency ■

Full name of a person to contact in case of emergency

Emergency Contact Person's Phone ■

Phone number of registrant's emergency contact person

Contact person's relationship ■

indicate how the contact person is related to the registrant.

Specify other relationship

If you chose "other" or "other relative" above, specify the relationship (e.g. family friend).

Health issues or concerns

indicate if you have issues related to asthma, bad knees, arthritis etc...

Health - Allergies to medication

Church: Church Name ■

The congregation/assembly with which the registrant is associated.

Church: Pastor or Overseer ■

Add more than one name if applicable. (For example, in the case of local church which has no pastor but is governed by a group of overseers/elders.) Place each name on a separate line.

Church: Address ■

enter the address of the church that the registrant attends.

Church: Phone ■

enter the phone number of the church which the registrant attends

Verification ■

Form verification: Enter the characters you see displayed.

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