Hip Hop 1
Instructor: Ms. Gillian Ages: 6yrs-10yrs/ $20.00 Registration Fee / $ 80.00 per month/ 1 Hour Class
Dress Code:
All Hip Hop courses require form fitted sweats, Jazz shoe slip-on black split sole NOT full sole and hair pulled back into ponytail or bun.
Registration & Payment Information:
There is a $20.00 registration fee. Registration Forms are only accepted when accompanied by payment. If you submit a registration form without payment your child is not considered registered, and their spot will not be held. Payment is $80.00 monthly and can be submitted by Venmo: Virginia Dill @virginia-dill or PayPal: 757-717-7187. Please include your child's name, class day and time on payment.
Select Class Day & Time:
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Thursday 5:00pm - 6:00pm
Child's Name:
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First Name
Last Name
Child's Date of Birth
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Month
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Day
Year
Date
Are there any Allergies/Medical Issues we should be aware of:
blanks
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Home Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name:
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First Name
Last Name
Mother's Email:
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example@example.com
Mother's Phone Number:
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Please enter a valid phone number.
Father's Name:
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First Name
Last Name
Father's Email:
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example@example.com
Father's Phone Number:
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Please enter a valid phone number.
Emergency Contact #1 Name:
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First Name
Last Name
Emergency Contact #1 Email:
example@example.com
Emergency Contact #1 Phone Number:
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Please enter a valid phone number.
Emergency Contact #2 Name:
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First Name
Last Name
Emergency Contact #2 Email:
example@example.com
Emergency Contact #2 Phone Number:
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Please enter a valid phone number.
understand that if my registration fee is not submitted in full on the same day as my registration, my registration is null and will be deleted from submissions.
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