Our six visit punch pass is valid for our Adult Hip Hop class only. Please disregard dates on registration st they are for administration purposes only. **PUNCH PASSES EXPIRE 6 MONTHS FROM DATE OF PURCHASE AND ARE NON-TRANSFERRABLE. CANNOT BE REDEEMED FOR CASH AND HAS NO VALUE. WE DO NOT REPLACE LOST/STOLEN PUNCH CARDS**
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
Please enter today's date*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*