Registration
Scratch night is kind of like Open Mic night for Aerial. Come and perform your own choreographed routine as a solo or ensable. *Guests are free to attend. * All acts must be approved by Jacque one week prior.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact ( Name & Phone Number )*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Which apparatus are you interested in performing on? Note: you must be attending that class regularly? You can pick more than one if you are in multiple disciplines. *
Who will you be performing with?
Which song will you be performing to?
 
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:*