Registration

1 openings left in this event!

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

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

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)

Students entered below will be added to your family's account

Add New Student #1:

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Questions/Options:


Child's Name(s) First and Last*
Date of Birth *
Guardian's name and cell phone for contact while child is at party*
Are you a member at Dance With Me School of Dancde*

Additional Information:

Waiver

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I've read the above and agree.

Photo and Media Release

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I've read the above and agree.

Enter your Full Name: