Event and Trial Class Registration Form

1

Your Contact Information* This field is required.

First name

Last name

Phone number

Email

2

Are you signing up for a free class or for an event?

Free Class

Event

3

Select one date for your free trial class:* This field is required.Free trials take place during from 10-11 am at Wildwood Park in Mount Airy

September 28

4

Which event would you like to attend:You may choose more than one option.

Lantern Walk - Exact Date TBD

5

First Student Name* This field is required.

First name

Last name

6

Child's Birthday* This field is required.

Date

7

Register a second student?* This field is required.

YESNO

8

Second Student Name* This field is required.

First name

Last name

9

Child's Birthday* This field is required.

Date

10

Register a third student?* This field is required.

YESNO

11

Third Student Name* This field is required.

First name

Last name

12

Child's Birthday* This field is required.

Date

13

Please share information, such as allergies or special needs, that the teacher should be aware of:

14

Name of caregiver who will attend classes with student(s)* This field is required.

15

Would you like to subscribe to our emails?

YESNO

16

Do you grant permission for pictures of your child to be taken during class? Pictures will be sent to families after class in a post-class email.* This field is required.Note: Photos taken will NOT be used in marketing materials or on social media unless a guardian separately approves a specific picture can be shared.

YESNO

17

By selecting "I accept," you agree to the terms in the release of liability waiver.* This field is required.