BALLROOM REGISTRATION

Student's Name*
First Last
Partner's Name
First Last
Student's Birthdate*
MM slash DD slash YYYY
Partner's Birthdate*
How did you hear about us?*
Class(es) student is interested in taking:*
All of our classes are on Saturday mornings.
- Ballroom Dance: Beginner I (ages 12+) - Saturdays, 10:15-11:15 AM
- Ballroom Dance: Intermediate I (ages 12+) - Saturdays, 9:00-10:00 AM
Primary Contact Phone*
Primary Email*
Almost all communication is via email, so please enter an email address that you check on a regular basis.
Enter Email Confirm Email
Primary Contact Address*
Street Address City ZIP Code
Emergency Contact: Name*
Different from the primary contact person listed above.
First Last
Emergency Contact: Phone Number*
Enter a contact number that is DIFFERENT from the primary number listed above.
Any medical needs or allergies we should know about?*
AFAA Liability Waiver*
I understand that by checking this box, I am indicating that I have read and agreed to to the conditions outlined on the AFAA Liability Waiver
Comments or Questions?