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
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DOAHL Hip Hop 4 Me Registration