Diverse Moves Dance Studio
Fill the registration form below
Parent/Guardian
*
First Name
Last Name
Phone Number
*
E-mail
example@example.com
Student
*
First Name
Last Name
Student Gender
Male
Female
Age:
*
Birthdate
-
Month
-
Day
Year
Date
Additional Student
First Name
Last Name
Age:
Birthdate
-
Month
-
Day
Year
Date
Additional Student
First Name
Last Name
Age:
Birthdate
-
Month
-
Day
Year
Date
Additional Student
First Name
Last Name
Age:
Birthdate
-
Month
-
Day
Year
Date
Emergency Contact
*
First Name
Last Name
Phone Number
*
Relationship To Student
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Known Allergies:
Allergies to Medications:
Current Medical Conditions:
Current Medications:
Monday Available Class Selection
Teenie Weenie Hip Hop /Age 3-4 ( 4:30PM-5:00PM)
Monday Big Kids HipHop/Age 5-6 ( 6:15PM-6:45PM)
Monday Tumbling Available Class Selection
Tumble Bugs/Age 4-6 ( 5:15PM-6:00PM)
Tuesday Available Class Selection
Boys Hip Hop /Age 7-12 ( 5:15PM-6:00PM)
Big Shots Hip Hop / Age 4-6 ( 6:15PM-6:45PM)
Thursday Available Class Selection
Intermediate Hip Hop/Age 12+ (430-5:00PM)
Junior Youth Hip Hop/Age 7-12 (5:15PM-6:00PM)
Thursday Tumbling Available Class Selection
Tumble Groove /Age 7-12 (5:15-6:00PM)
Mighty Mini's Tumble/Age 4-6 (6:15PM-7:00PM)
Please Pay To Complete Your Registration (Additional Student/Class is $30 Per Mo)
*
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Dance Registration Fee + First Month
$
75.00
Quantity
1
2
3
4
5
6
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9
10
Tumbling Registration Fee + First Month
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Additional Student
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Additional Class
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
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