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Student First Name*

Student Last Name*

Date of Birth*

MMAC is committed to inclusivity and honoring each student. Please share with us your dancer's preferred pronouns:*

Are you the legal guardian of the enrollee?

Guardian First Name*

Guardian Last Name*

Email Contact*

Mobile Contact*

If the emergency contact is different than Guardian Contact, please list Emergency Contact: First Name, Last Name, Mobile Contact and Email Contact.*

My dancer's level of experience is*

I would like to enroll in the following classes:*

Allergies*

Pre-existing injuries and/or illnesses:*

I would like to set up automatic payments for the 1st of the month*

Will you need to purchase or rent PBT equipment? If so, please list.*

How did you hear about MMAC?*

If you were referred by a current student or instructor, please share with us so that we may express our gratitude through the Refer a Friend Thank You Program.

I have completed my online tuition payment to reserve my place at the barre.*

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