Registration


WIGGLE WEDNESDAY!

We are located at 11252 Balls Ford Road Manassas, VA 20109

Connect with other parents within our community once a month.
Join us once a month for a creative movement class, circle time,
craft, obstacle course, and coffee for parents!

Attire


*Comfortable clothes you can move around in.
*Parents, please wear socks.

Cost


10/per dancer
*There is no fee for the parent/guardian participating with their child

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
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Liability Release
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I've read the above and agree.
 
Photo Release
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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:*