Vogler Dance Studios Student Information Sheet

Student complete name:___________________________________________

Year, month, and date of birth ______________________________________

Grade in School as of September 1st. ____________

School Name ___________________________________________________

Does your child have any chronic physical ailments, medical restrictions, or other special considerations that we should know of? If yes, please be specific. _____________________________________________________________________________

_____________________________________________________________________________

Person responsible for paying tuition ___________________________________

Motherís complete name ___________________________________________

Address ________________________________________________________

City and Zip code _________________________________________________

Home Phone ___________________ Work Phone _______________________

Motherís place of employment ________________________________________

Cell Phone ____________________ e-mail _____________________________

Fatherís complete name _____________________________________________

address _________________________________________________________

City and Zip ______________________________________________________

Home phone ___________________ Work phone ________________________

Fatherís place of employment _________________________________________

cell phone ____________________ e-mail ______________________________

Person responsible for transportation if other than parent. Please include phone number

______________________________________________________________________________

Please list a relative or neighbor that I can call in case of an emergency.

______________________________________________________________________________

If your child has studied dance, baton twirling, or gymnastics at another school other than Voglerís Studio last year please tell me where and try to give me some indication of what subjects she has studied and for how long.

_______________________________________________________________________________

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