Registration Form

K.C.’s Dance & Cheer Center
6300 Industrial Drive Suite 1
Sachse, TX 75048
www.kcdanceandcheer.com

Account Information

First Name(s) *      Last Name:

Address 1      Cell Phone #:      Work #:

     Mother's email address:

     City:      State #: *      Zip #: * * E-mail * (for example: myname@gmail.com)

 

Child/ren Information
Please provide your child/ren name(s) and age.

 

Child 1 Name * Age *
Child 2 Name Age
Child 3 Name Age
Child 4 Name Age

 

How did you hear about us?
More Details

 

Emergency Contact Information
Who should we contact, other than the contact listed above, in case of an emergency?

 

Emergency Contact Name(s)
Emergency Contact Phone(s)
*

By checking this box, I acknowledge that I have read and understand the above information.

Parent/Guardian name:* Date:
* = required

 

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