Course Registration Form

K Dreamz Lux Lounge Registration Form

Fill out the form carefully for registration
Name Of Child/ Name Of Business Owner/ Event Organizer Name*

First NameMiddle Initial Last Name
Birth Date*

MonthDayYear
Gender*
Child Age
Grade
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School of child/ Business Name/ Type of Event *

School Name/ Grade

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Emergency Contact Information *
Event You Are Signing Up For*
Additional Kids/ Comments…… Please list any medical conditions or concerns *
Should be Empty:

K Dreamz Lux Lounge Registration Form