Girls Summer Dance and Fitness Program

Registration Form

Child's Name(Required)

First Last

Child's Grade Entering in the Fall(Required)

1st and 2nd grade admissions are full

Child's School(Required)

Child's Address(Required)

Street Address City State ZIP Code

Mother's Name(Required)

Mother's Cell #(Required)

Father's Name(Required)

Father's Cell #(Required)

Parent E-mail Address(Required)

Emergency Contact Name(Required)

Emergency Contact Number(Required)

Entering 3rd/4th Grade(Required)

Price:

Entering 5th/6th/7th/8th Grade(Required)

Entering 5th, 6th, 7th & 8th Graders- Session 2 (August) $30

Total

Credit Card(Required)

Card Details

Cardholder Name

This field is for validation purposes and should be left unchanged.