HCS Harvest Dance Registration
April 16th // 6:00 PM-11:00 PM // Alexanders; 179 Honeysuckle Road, Suite 6, Dothan, AL 36305
Name
*
First Name
Last Name
Parent's Names: Mother and Father
*
First Name
Last Name
First Name
Last Name
Parent's Email
*
example@example.com
Student email (if applicable)
example@example.com
Home Phone
*
-
Area Code
Phone Number
Student Contact if different from parent
-
Area Code
Phone Number
Church Cover School
Guest Name
First Name
Last Name
Guest Parent Name
First Name
Last Name
Guest Parent Phone Number
-
Area Code
Phone Number
Guest Parent Email
example@example.com
School
Does your student have permission to drive to/from event?
Yes
No
Does your student have permission to leave early?
Yes
No
Click Here to view the Dress and Conduct Code
I have read and agree to the Dress Code and Code of Conduct for this dance.
*
I agree
Purchase Tickets
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HCS Spring Formal Tickets
$
40.00
HCS Formal Dance Tickets
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
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