Enrollment | Remedy Elite Dance Company LLC

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*Athlete's First Name

*Athlete's Last Name

*Athletes D.O.B

Month

Day

Year

*Age

*Grade Level

*Headshot

Do your athlete(s) have any allergies, asthma or any medical conditions that would limit high level activity? If yes , please explain:

*Parent / Guardian Name

*Phone

*Address

*Email

Signature

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Registration Fee

$30

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Tel: 214.989.5474

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