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Youth Registration

We are asking you to fill out this form for any youth(s) ages 8-19 yrs. who participates in CMDE’s dance classes. We are REQUIRED to collect certain data on all participating students. Information is kept confidential. We realize that filling out paperwork is an inconvenience, but it will help us help you! Thank you in advance for your assistance!

First Time Youth Class Registration Form 2025
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Name
Sex
Student’s Race/Ethnicity:
Referral Source Type
Annual Income of Parents:
Parent Source of Income:
Youth Employment Status:
Type of School:
School Status:
School Classification:
Family:
Living Arrangements:
Primary Caregiver:
Problem Areas:
Parent/Guardian Name (if Minor)
Parent/Guardian Name 2 (if Minor)
Emergency Contact Name
Address
Tuesday Class
Thursday Classes
Sunday Classes
SPRING SESSION 2025
May we use yours or your child's photos or videos for publicity purposes?
Does student have any disabilities or special needs?
Clear Signature
$0.00

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