Please fill out the student and parent information below.
Type N/A for any fields that aren’t applicable.
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Student Last Name *

Student First Name *

Street Address *

City *

Zip Code *

Home Phone *

Student Birth Date *

Age *

Grade Level / School *

Parent/Guardian Last Name *

Parent/Guardian First Name *

Place of Employment *

Work Phone *

Cell Phone *

Email Address *

Emergency Contact *

Emergency Contact Phone *

How did you hear about Curtain Call? Please check *

Referral

Dance Performance

Website

Direct Mail

Other

If you were referred to Curtain Call, please list the student or parent's name. Our referral program rewards those who recommend us. If you weren't referred to us, type N/A. *