Returning Dancer Form

Dancer's Name *

First Name

Last Name

Dancer Birthdate *

MM

DD

YYYY

Dancer Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please Select Your Family's First Choice *

Please note: this is not a guarantee of registration in the class. Class placement will be confirmed by AIM Staff via Email before the session begins.

Adaptive Dance - Wednesday 11:15 AM-12:15 PM (Ages 2-5)

Adaptive Dance - Saturday 12:15-1:15 PM (Ages 5-12+)

Adaptive Dance - Saturday 1:25-2:25 PM (Ages 12-30+) FULL!

Adaptive Dance - Sunday 3:30-4:30 PM (Ages 12-30+)

Adaptive Dance - Sunday 4:45-5:45 PM (Ages 12-30+)

Please Select Your Family's Second Choice *

Please note: this is not a guarantee of registration in the class. Class placement will be confirmed by AIM Staff via Email before the session begins.

Adaptive Dance - Wednesday 11:15 AM-12:15 PM (Ages 2-5)

Adaptive Dance - Saturday 12:15-1:15 PM (Ages 5-12+)

Adaptive Dance - Saturday 1:25-2:25 PM (Ages 12-30+) FULL!

Adaptive Dance - Sunday 3:30-4:30 PM (Ages 12-30+)

Adaptive Dance - Sunday 4:45-5:45 PM (Ages 12-30+)

I am available for all the age-applicable class options:

Yes

No

Are you planning on using DDA Respite Funds to pay for these classes? *

Yes

No