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Forever Evolving Youth Creative Dance Empowerment Program
Please complete the registration form for participation in our creative dance program.
*
Indicates required field
Participating Youth Name
*
First
Last
Age
*
Ages 4-18 ONLY
Parent/ Guardian Contact Information
Parent/Guardian Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Which program are you registering for?
*
Year Round Dance Program
Summer Dance Camp
Emergency Contact
In case of emergency, please provide emergency contact information the participating child.
Emergency Contact 1 Name
*
First
Last
[object Object]
Emergency Contact 2 Name
*
First
Last
Phone Number
*
Phone Number
*
Medical Information
Please provide any health/medical information for the participant.
Medical Information
*
Allergies
*
Approved Pick Ups
Approved Pick Up Name 1
*
Relationship to Participating Youth
*
-Select-
Mother
Father
Sister
Grandparents
Brother
Aunt
Uncle
Cousin
Family Friend
Approved Pick Up Name 2
*
Relationship to Participating Youth
*
-Select-
Mother
Father
Sister
Brother
Grandparents
Aunt
Uncle
Cousin
Family Friend
Approved Pick Up Name 3
*
Relationship to Participating Youth
*
-Select-
Mother
Father
Sister
Brother
Grandparents
Aunt
Uncle
Cousin
Family Friend
I agree to receiving marketing and promotional materials
Register
Home
About Us
RG Departments
The ReFresh Institute
>
Course Catalog
Scholar Academy Portal
Life Wire
ReFresh Kidz
ReFresh-A-Life Outreach/Missions
Get Involved!
Executive Global Partners
ReFresh Global Publishing
ReFresh Portal
Store
Contact Us