Seussical Jr. Registration

 

First Name
Last Name
Age
Gender Female   Male
Address  
City    
State   Zip
 Parent/Guardian Full Name
Email Address
Emergency Contact #

I authorize the use my of child's photo/likeness by Sell’s Broadway Dance Company for the purposes of promoting the dance studio. The media my include, but is not limited to, brochures, flyers, website, etc.

Special Notes
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