CENTRAL VALLEY STARS FREE DANCE CLINIC REGISTRATION
SATURDAY SEPTEMBER 11, 2010
DANCE SCHEDULE
10:00 a.m. - 11:00 a.m.
Ages 3 thru 5
11:00 a.m. - 12:00 p.m.
Kindergarten to 2nd Grade
12:00 p.m. - 1:00 p.m.
3rd Grade to 6th Grade
1:00 p.m. - 2:00 p.m.
7th Grade to 12th Grade
Session Attending*
Ages 3 to 5: 10:00 am to 11:00 am
Kindergarten to 2nd Grade: 11:00 am to 12:00 pm
3rd Grade to 6th Grade: 12:00 pm to 1:00 pm
7th Grade to 12th Grade: 1:00 pm to 2:00 pm
Parent/Guardian Information
*Required
First Name:*
Last Name:*
Address:*
State: CA
City:*
Postal Code:*
Phone:*
ex. 559 271 1064
Email:
ex. centralvalleystarsinfo@centralvalleystars.com
How you heard?
Facebook
Google Search
Yahoo! Search
MSN/Bing Search
Referred
School Flyer
Other
Decline to State
Other or referred?
Student Information
*Required
First Name:*
Last Name:*
Age:*
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
School:
IMPORTANT!
RELEASE:
I hereby release Central Valley STARS, STARS National Dance Program, all staff officials from all claims of damages or injury suffered by the students named above in connection with their association with Central Valley STARS and STARS National Dance Program.. This includes my heirs who may not act in my behalf. Please consult your physician before yourself or child begin any new physical exercise.
Please type your initials that you agree with the above statement
Date: February 15, 2012