Online/ Private Dance Lesson Enrollment Form

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Student's Name
First Name
Last Name
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Email Address
example@example.com
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Phone Number
Please enter a valid phone number.
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What level of the lesson would you prefer?
Please Select
Please Select
Beginner
Elementary
Intermediate
Upper Intermediate
Advanced
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Which class are you interested in enrolling?* This field is required.
Erotic Chair Dance Lessons
Erotic Non-Chair Dance Lessons
Other
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I am interested in... (Please select all that apply.)* This field is required.
Private Lessons
Small group lessons
Couples Lessons
Other
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I am interested in... (Please select all that apply.)* This field is required.
In-Person Lessons
Virtual Lessons
Other
Both Virtual and In-Person Lessons
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What is your purpose of taking lessons?
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Do you currently have an exercise/movement regimen?
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How often do you exercise or move your body?
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On a scale of 1 to 10, please rate your passion or curiosity for dance.
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Have you taken dance lessons before?If 'Yes', please describe your dance experience in a couple sentences, however great or small...
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How ready are you to start integrating dance into your life NOW?* This field is required.
I am So ready! Let's Dance!
I really want too but may need more information.
Other
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What type of dance most interests you?
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What are the biggest obstacles getting in the way of accomplishing your dance goals? Please elaborate.
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Do you have any physical or health limitations that we should know about before we begin? Please elaborate. It is your responsibility to ensure you are cleared by your qualified healthcare practitioner for movement. Otherwise, feel free to indicate any recent or past injuries. We will work within your capabilities!
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Thank you SO MUCH for taking the time to complete the Kitty Power Dance Class Enrollment Form. The information that you have provided will remain confidential and will help me in providing you with the most invaluable and extraoradinatry dance experience.

To complete your enrollment process, please submit your intake form.

If you have any questions, pelase email: IndyaPittman@KittyPowerworkshop.com
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When would you like to take Dance lessons?Avaliable Mon -Fri 10am- 9pm| Saturdays and Sundays 10am -11pm EST| *(Please select multiple time sessions)
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ORDER SUMMARY
Total costUSD
1 hr Virtual Dance Sessions
1hr Virtual Dance Session
$50.00Edit
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Quantity
1 hr In-Person Dance Lessons
Includes travel to customers desired location within a 25 mile radius. Additional travel fees may apply
$100.00Edit
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Quantity
2 hr Virtual Dance Session
Must be used in one booking
$90.00Edit
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Quantity
2 hr In-Person Dance Class Session
2 hr session must be used in one booking
$180.00Edit
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Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
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