Ballet Folklorico Los Mextucaz Registration Form
"Compartiendo La Cultura de Mexico"
ONLINE CLASS SCHEDULE
Level 1A
Toddlers
2 year olds only
Thursdays
4:20 PM - 4:50 PM
Level 1B
Toddlers
3-5 year olds
Thursdays
4:55 PM - 5:35 PM
Level 2
Beginners
Mondays & Wednesdays
4:00 PM - 5:00 PM
Level 3
Intermediate
Mondays & Wednesdays
5:30 PM - 6:45 PM
Level 4
Advanced
Class is currently combine with our level 5
Level 5
Advanced Adult
Tuesdays & Fridays
4:00 PM - 6:45 PM
Level 6
Beginner Adult
Thursdays
5:45 PM - 6:45 PM
Student Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
Gender
Male
Female
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Write something about yourself
Parent/Guardian
For minors (below 18 years of age)
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Relationship
*
Emergency Contact Information
Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship
Miscellaneous
How do you learn about this online dance class?
Facebook
Twitter
Instagram
YouTube
Search Engine
Online Ads
Referral
Other
Do you want to add enroll more students?
Yes
No
Additional Students
*
Additional students
Payment & Confirmation
Registration Fee
*
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Level 1 Toddlers
$
40.00
$25 monthly fee plus $ 15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Level 2 Beginners
$
60.00
$45 monthly plus $15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Level 3 Intermediate
$
60.00
$45 monthly plus $15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Level 4 Advanced
$
60.00
$45 monthly plus $15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Level 5 Advance Adult
$
60.00
$45 monthly fee plus $15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Level 6 Beginner Adult
$
40.00
$25 monthly plus $15 registration fee
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Payment Method
CASH
CREDIT CARD
CASH APP $LosMextucaz
ZELLE
VENMO LosMextucaz
Other
Signature of Legal Gaurdian
Date Signed
-
Month
-
Day
Year
Date
Parent/guardian Name
First Name
Last Name
Parent/guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
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