ConfiDanse DROP IN

Drop in Registration Form

Open Level Heels W/ Dorian | Wednesdays 6:30-7:30PM
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number. ConfiDanse will text the door code upon registrationFormat: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Level of Experience
Are you currently enrolled for our 90s-00s session? (If yes, there is a discounted rate)
Medical Conditions or Allergies
Terms and Conditions:

By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release ConfiDanse studio and its instructors from any liability for injuries or accidents that may occur during classes or events.
Signature
Date signed

MonthDayYear
Date
Non Registered Students

$21.00

Registered Students

$15.00

** Email Transfer to confidanseinfo@gmail.com

within one hour to complete registration **
Should be Empty:

Drop in Registration Form