Winter Break Dance Party

Saturday, December 27, 2013
10am-3pm


You're invited - just fill out the form to the right to sign up!

Sign Up Here for the Winter Break Dance Party

Student Information:
Name: *
Phone: *
Street Address:
Age:
Date of Birth:
City:
Zip Code: (5 digits)
Student Cell Phone:
Student Email Address:
Account Information:
Mother's Name:
Mom's Work or Cell Phone:
Father's Name:
Dad's Work or Cell Phone:
Email Address:
Emergency Contact:
Relationship:
Emergency Contact Phone:
Billing Information:
Name (for Billing):
Phone (for Billing):
Address (for Billing):
Town (for Billing):
Zip (for Billing):


LIABILITY DISCLAIMER: The studio, its staff, and its instructors are not liable for personal injury, loss or damage to personal property. Since this is a physical activity, injuries may occur. Each student may decline to participate in any activity, which he/she may consider to be harmful. It is the student’s responsibility to inform the instructor of any physical limitations, which may prevent full participation in class. Registration fee is non-refundable.

By submitting this form, you acknowledge that you have read and understood the agreement and agree to all its terms and conditions.

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