Student # 1. Full Name *

First Name

Last Name

Student # 1. Birth Date *

MM

DD

YYYY

Student # 2. Full Name

First Name

Last Name

Student # 2. Birth Date

MM

DD

YYYY

Student # 3. Full Name

First Name

Last Name

Student # 3 Birth Date

MM

DD

YYYY

Student # 4. Full Name

First Name

Last Name

Student # 4. Birth Date

MM

DD

YYYY

Parental Information *

Parent/Guardian Full Name

First Name

Last Name

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Select the classes you are registering. If registering multiple students, check the appropriate box below. *

Dance Lesson - $49/month - Every Thursday 6-9pm and Sunday 2-5pm. Each class is one hour divided by age group.

Student # 1 -Dance

Student # 2 -Dance

Student # 3 -Dance

Student # 4 -Dance

I don't want to take Dance classes

Accordion Lessons - $25 per student, per class(minimum 4 classes per student) -Every Saturday, 2-3pm *

Student # 1 -Accordion

Student # 2 -Accordion

Student # 3 -Accordion

Student # 4 -Accordion

I don't want to take Accordion classes

Baraban Lessons - $25 per student, per class(minimum 4 classes per student) -Every Saturday, 3-4pm *

Student # 1 - Baraban

Student # 2 - Baraban

Student # 3 - Baraban

Student # 4 - Baraban

I don't want to take Baraban classes

Karachay Language Class - Free for all ages. Every Thursday 6-7pm. *

Student # 1 for Language

Student # 2 for Language

Student # 3 for Language

Student # 4 for Language

I don't want to take Karachay Language classes