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Student:_______________________________________________
Age:________________________D.O.B_____________________
Parent(s):_______________________________________________
Address:_______________________________________________
City:_____________________________
Zip:_________________
Home phone:________________ Cell/Work:__________________
Email:______________________________
Childcare
Center:______________________________
Location:_______________________________________________
(Name of street, road or highway)
Please check program preference for your child's school.
Acceptance is subject to course availability.
Call
678-482-2264 or check with your child's school for specific
programs offered there
| Lil' Champs:_____
|
Champs:_____ |
All-Stars:_____ |
Church Enrichment:_____ |
|
(ages
2.5-3.2) |
(ages
3.5-4) |
(ages
5-up) |
|
I have read and understand
the information provided in this website.
I waive any right to claim
against Creative Movement and Dance, Inc. owners, staff, and
teachers
in the event of accident,
injury or loss of personal items. To review policies,
click here.
Signature:__________________________________Date:___________
Pay by
Credit Card: Visa / Mastercard (please circle)
Card Number:_____________________________________
Exp. Date:______________________________________
Amount to pay:__________________________________
|
MAIL
THIS PAGE WITH $100.00 TUITION
PAYABLE
TO:
CREATIVE
MOVEMENT AND DANCE
P.O. BOX 390278
SNELLVILLE, GA 30039
Fax: 770-934-8849
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