Registration
Country Western Dance with a Partner or without! The two-step, polka, waltz and jitter bug will be covered during this 6 week session. Childcare is available at $50 additional fee per child during the class for the full 6 weeks. No refunds. Fee is per couple. Single is the same price as a couple. *REGISTRATION IS PER COUPLE or a single, not family as indicated on the form.* Class meets every Sunday starting September 22 - October 27 from 5-6pm.
Event:
Start Date/Time: End Date/Time:
Fee per Family: 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)*
 
 
 
Questions/Options:
Will you be a couple or individual?*
What are both names of the couple participating?*
Are there any medical conditions that we should be aware of? If you please indicate in the comments below*
Will you need childcare?*
Names and Ages of Children to participate in childcare. *$50 fee will be charged at registration for each child*
 
Additional Information:
 
 
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:*