Registration

Wanting to try out that amazing new restaurant you've heard about? Just wanting some peace and quiet? We have the solution: Parents Night Out at Expressions in Rhythm Studio! Let us entertain your kids while you do something for YOU! Space is limited so sign up TODAY!
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
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
 
Questions/Options:
How did you hear about us? *
Child's Name*
Best Contact Number (Please include the area code)*
E-mail Address*
Date of Birth*
Parent/Guardian's Name*
Medical Concerns/Allergies/Disabilities/Other*
Does your child attend Expressions in Rhythm Studio?*
If no, name of the Expresser your child is a guest of*
Previous Dance/Drum Experience?*
If you answered yes to previous dance/drum experience, please state where and when.*
 
Additional Information:
 
Assumption of Risk & Release of Liability
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I've read the above and agree.
 
Agreement
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
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:*