2023 Fall Music & Movement Registration

"*" indicates required fields

Accompanying Adult*

First Name Last Name

Email Address*

Phone*

How many dancers are you registering?*

Dancer 1*

First Name Last Name

Date of Birth (Dancer 1)*

Class Day and Time (Dancer 1)*

Tuesdays from 9:15am to 9:45am (October 3rd through November 7th) (9 spots left)

Saturdays from 9:00am to 9:30am (October 7th through November 11th) (1 spots left)

Dancer 2*

First Name Last Name

Date of Birth (Dancer 2)*

Class Day and Time (Dancer 2)*

Tuesdays from 9:15am to 9:45am (October 3rd through November 7th) (9 spots left)

Saturdays from 9:00am to 9:30am (October 7th through November 11th) (1 spots left)

Processing

Total

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code

Cardholder Name*

First Last

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Questions or Comments

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716.626.2498