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Funky Dance (2-5yrs) with Hannah K
Join Hannah online for our Funky Dance class!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Account/Family Information
First Name:
*
Last Name:
*
Type
*
Dancer
Father
Grandfather
Grandmother
Guardian
Mother
Other
Parent
Partner
Spouse
Step Parent
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Postal Code:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Dancer Gender:
*
Female
Male
Other
Birth Date:
*
(format=dd/mm/yyyy)
Dancer Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Previous Dance Experience:
*
Instagram Handle:
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Exp Year:
*
2024
2025
2026
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Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
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