Ballet Folklorico Los Mextucaz Registration Form

Ballet Folklorico Los Mextucaz Registration Form

"Compartiendo La Cultura de Mexico"

MEXTUCAZ CLASS SCHEDULE
Level 1A	Toddlers 2 year olds only	Fridays	4:00 PM - 4:30 PM
Level 1B	Toddlers 3-5 year olds	Fridays	4:30 PM - 5:10 PM
Level 2	Beginner	Mondays & Wednesdays	4:20 PM - 5:30 PM
Level 3	Inter-mediate	Mondays & Wednesdays	5:30 PM - 6:45 PM
Level 4	Advance	Tuesdays & Thursdays	4:20 PM - 5:30 PM
Level 5	Advance Adult Dancers must be ages 18+	Tuesdays & Thursdays	5:30 PM - 7:00 PM
Level 6	Beginner Adult	Fridays	5:10 PM - 6:00 PM

Student Information
Name

First NameLast Name
Age
Date of Birth
Gender
Phone Number
Format: (000) 000-0000.
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
Format: (000) 000-0000.
Email
example@example.com
Relationship
Emergency Contact Information
Contact Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship
Contact Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
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
$30 monthly fee plus $ 15 registration fee

$45.00 Quantity



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

$60.00 Quantity



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

$60.00 Quantity



Level 4 Advance
$45 monthly fee plus $15 registration fee

$60.00 Quantity



Level 5 Adult Advanced
$45 monthly fee plus $15 registration fee

$60.00 Quantity



Level 6 Adult Beginner
$30 monthly fee plus $ 15 registration fee

$45.00 Quantity



Total

$0.00
Payment Method
Signature of Legal Gaurdian
Date Signed

MonthDayYear
Date
Should be Empty: