Class Registration Form

Your 4 Steps away from Dancing yourself to.... a Happier way of Life!

Please register one student at a time.

Step 1. Student Information

Student Name:         Student Date of Birth:

Parent/Guardian Name:Email address:

Address 1: Address 2:

City:     State:   Zip Code:

Phone:       Best time to call?  Morning Noon Evening

Step 2. Class Selection

Your first month’s lesson fee is due at registration to reserve your spot in class! Registration is non-refundable and non-transferable. Online payment is recommended, but not mandatory.

If you choose to not pay online, skip to Step 4 select "Submit" to continue registration.

Step 3. Enter Credit Card Information

Name: (as it appears on card)
          Card Type:  VISA   MasterCard

Credit Card Number:
         Expiration Date:

3 Digit Security Code:  (back of card) 

Step 4.  Review your information, click  .... Submit...

Thank You!...Shelley                                                        

Last modified: October 08, 2008    The forms processing software supplied by www.tectite.com.