Hip Hop 4 Me Registration Form

DOAHL Hip Hop 4 Me Registration

DESIGNED FOR INDIVIDUALS WITH AUTISM,PHYSICAL AND INTELLECTUAL DISABILITIES. Please fill out the registration below to ensure your spot in our class.
Students Name

First Name Last Name
Parent/ Guardians Name

First Name Last Name
E-mail
Phone Number

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Gender

Male Female
Type of Dance

Hip Hop 4 Me
What are your child's triggers? i.e. Loud noise etc.
Allergies / Medication
Payment Option
NOTE: Please be advised that registration is not complete without full payment. When paying by EFT please send $60+ HST ($67.80) to dance@doahl.com to secure your spot. If you have any additional questions please contact us at dance@doahl.com or (647)285-8972
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm