STUDENT INFORMATION Student's Name:  * Birthday:  * Age:  * Entering Grade:  * School Attending:  * Has Your Child Taken Dance Before: NoYes If YES How Long: 0-1 Year1-3 Years3-5 Years5 or More Classes Interested In: Jazz Tap Ballet Acrobatics Hip-Hop   PARENT INFORMATION Mother's Name: Father's Name: Address:  * City:  * State:  * Zip Code:  * Primary Phone:  * Alternate Phone: Email is our primary form of communication. Please make sure your email address is typed correctly and list as many as you like. Primary Email:  * Additional Email:   EMERGENCY CONTACT INFORMATION Emergency Contact:  * Emergency Contact Phone:  *   HOW DID YOU HEAR ABOUT US: How did you hear about On Pointe: Returning StudentNews & NeighborMall Table AdGoogle (web search)BillboardPhonebookFriend   WAIVER AND RELEASE FROM LIABILITY Please click on the "RELEASE FORM" link below to view our release form information You must type your name in the space below to acknowledge that you accept the information provided in this form and release On Pointe/Mailworks from all liabilities mentioned in the form. THE PARENT/GUARDIAN'S NAME TYPED SHALL SERVE AS THEIR SIGNATURE AND RELEASE Type Name to Accept:  *   QUESTIONS OR CONCERNS: Comments: Security code:   * Do not enter anything in this field: