Ballet Folklorico Los Mextucaz Registration Form

Ballet Folklorico Los Mextucaz Registration Form

"Compartiendo La Cultura de Mexico"

ONLINE CLASS SCHEDULE
Level 1A	Toddlers 2 year olds only	Tuesdays	4:20 PM - 4:50 PM
Level 1B	Toddlers 3-5 year olds	Tuesdays	4:55 PM - 5:35 PM
Level 2	Beginners	Mondays & Wednesdays	4:20 PM - 5:30 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	4:20 PM - 6:45 PM 4:20 pm- 6pm
Level 6	Beginner Adult	Tuesdays	5:45 PM - 6:45 PM

Student Information
Name

First NameLast Name
Age
Date of Birth
Gender
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Write something about yourself
Parent/Guardian

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Emergency Contact Information
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Miscellaneous
How do you learn about this online dance class?

Other
Do you want to add enroll more students?
Additional Students
Additional students
Payment & Confirmation
Registration Fee
prevnext( X )
Level 1 Toddlers$40.00
$25 monthly fee plus $ 15 registration fee

Quantity

Level 2 Beginners$60.00
$45 monthly plus $15 registration fee

Quantity

Level 3 Intermediate$60.00
$45 monthly plus $15 registration fee

Quantity

Level 4 Advanced$60.00
$45 monthly plus $15 registration fee

Quantity

Level 5 Advance Adult$60.00
$45 monthly fee plus $15 registration fee

Quantity

Level 6 Beginner Adult$40.00
$25 monthly plus $15 registration fee

Quantity

Total $0.00
Payment Method

Other
Signature of Legal Gaurdian
Date Signed

MonthDayYear
Date
Parent/guardian Name

First NameLast Name
Parent/guardian Signature
Date Signed

MonthDayYear
Date
Should be Empty: