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At JDM, we believe in creating positive experiences and lasting memories. The Daddy Daughter dance is an experience that will last a lifetime! Spending time at rehearsal & working through choreography with your daughter is never time wasted. The memories of class, in fact, are as significant as performing the actual dance on stage in front of an audience. This time with your daughter is for you and your daughter. PRICE: $99.00 PER FAMILY (COSTUME NOT INCLUDED)

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *

Additional Information:

Other Questions/Comments:

Please fill out ONE of the following Payment Methods.

Credit Card Verification:

Card Number:

Name as it appears on card:

Nickname:

Card Expiration Month:

Exp Year:

Address Line 1:

Address Line 2:

City:

State: Zip:

eCheck/Bank Draft:

Bank Name:

Bank Routing Number:

(9-digit number)

Your Account Name:

(Your name on your bank statement)

Your Account Type:

Account Number: