Registration
3-7 year olds will be from 6:00-7:30 pm Pre-Registration| $25 for mom and 1 daughter, $5 for additional children At the Door| $35 for mom and 1 daughter, $8 for additional children Get all dressed up and dance the evening away 80's Style! Drinks and snacks will be provided! The event will be held at the YWCA. *If you plan to bring more than one daughter with you, you will need to register them separately. Price adjustments will made before your card is charged.
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
 
Questions/Options:
Mom's Name*
Child's Name*
Child's Age*
Additional Children's Names & Ages*
Contact Email & Phone Number
 
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:*