A Chance to Dance
Fill out the form carefully and sign up each participant.
Class Date
July, Friday 5th - NO CLASS HOLIDAY 5:00 - 6:00 pm
Class Date
July, Friday 12th, 5:00 - 6:00pm
Class Date
July, Friday 19, 5:00 - 6:00pm
Class Date
July, Friday 26th, 5:00 - 6:00pm
Class Date
May - 31st 5th week no class
Class Participant Name
*
First Name
Last Name
Gender
*
Male
Female
N/A
Age
*
Ethnicity
*
Hispanic/Latino
African American
Asian
White Caucasian
Other
City where you live
*
Family/Parent/Guardian Name
*
First Name
Last Name
Number in Household
*
Number over 62
*
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
My Products
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July Monthly Family Donation
$
50.00
July Monthly Family Donation
July Monthly Family Donation
$
75.00
July Monthly Family Donation
July Monthly Family Donation
$
100.00
July Monthly Family Donation
Already donated this month via Zelle, Cash, Check or Online Banking!
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Free
Please hit PayPal to check out. (Zelle - rocknourdisabilities@gmail.com)
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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the form.
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