Creative Movement and Dance Logo for Heather Pace

Fax: 678-229-6198
SUMMER WORKSHOP REGISTRATION PRINT OUT FORM

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 678-229-6156 or check with your child's school for specific programs offered there

Pre-Ballet:_____ Tap-Ballet:_____  Hip-Hop:_____

 

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:___________

   

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Card Number:_____________________________________
Exp. Date:______________________________________
Amount to pay:__________________________________

 

Click here for Monthly Billing Authorization Form

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MAIL THIS PAGE WITH $95.00  TUITION 

PAYABLE TO:

CREATIVE MOVEMENT AND DANCE
PO Box 690
Kennesaw, GA 30156

 

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