Barre Class Registration and Payment
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Injuries
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
What day works best with your schedule?
*
Monday 6:45-7:30
Thursday 7:15-8:00
Both days
My Products
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( X )
4 Classes
$
40.00
Unlimited Monthly Classes
$
65.00
Drop In
$
12.00
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card
Submit
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