Dazzl’R Twist Dance Academy

A complete professional dance institute

Registration Form
 Please Fill Up All the Following Information Only In Capital Letter with Black or Blue Ballpoint Pen
Only.

1. Student’s Name ………………………………………………………

2. Father’s Name ……………………………………………………....
3. D.O.B …………………………………….
4. Gender  Male
 Female
5. Permanent Address
Vill …………………………………………………………………

P/O ………………………………. P/S …………………………..

District ………………………………. Pin …………………………..

6. Present Address
Vill ………………………………………………………………….

P/O ………………………………. P/S …………………………...

District ………………………………. Pin …………………………...

7. Contact No …………………………. Whatsapp No …………………….

8. Email Id …………………………………………………………………
9. Name Of School/College/Institute
………………………………………………………………………………………….
10. Address Of School/College/Institute
………………………………………………………………………………………….

 Please Tick out  Student Group by Age

 Group “A” (3 To 5 Years)
 Group “B”(6 To 8 Years)
 Group “C”(9 Years To Above)

Signature Of Student Signature Of Guardians

Signature Of Form Receiver Dance Trainer

Dev Raj (6394790419)