Chorus/Dance Registration Child's Name(Required) First Last Birthdate(Required) MM slash DD slash YYYY Grade level(Required) HiddenAge(Required)Child identifies as(Required)GenderMaleFemaleDoes the child have a disability?(Required) Yes No What is their primary diagnosis?(Required)Are there any additional diagnoses?(Required) Yes No What are the additional diagnoses?(Required)Primary Contact(Required) First Last Phone(Required)Email(Required) Secondary contact (optional) First Last Phone for secondary (optional)Email for secondary (optional) Home address(Required) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child's phone (if applicable)Past Variety Theatre showsPast Variety Children's ChorusPast Variety DanceFor the 2022-23 school year, the child wants to participate in(Required)Select oneVariety Chorus onlyVariety Dance onlyBoth Chorus and Dance Δ
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