Registration form - Just Dance

Name:*

Date of Birth:*

Age:*

Email:*

Telephone Number:*

Address:*

Do you have any illness, allergy or injury that we need to be aware of?*

Please give details:*

I agree to inform the teacher if I am pregnant.*

Permission for photos on Just Dance Website?*

Permission for photos on Just Dance Facebook page?*

Permission for photos on Just Dance Instagram?*

Permission for photos on Just Dance Pinterest?*

Permission for photos on Just Dance YouTube?*

Where did you hear about Just dance?