RODF Hip Hop Class Registration Form

New Location

Rick Novack

13558 Palm St. Hesperia, CA 92344
Choir Class

Fill out the form carefully and sign up of each participant.
Class Date*

March 4th, 11th, 18th, 25th. Tuesdays, 5:00 - 6:00 pm
Class Participant Name*

First NameLast Name
Gender*
Number over 62*
Age*
Number in Household*
Ethnicity*

Hispanic/LatinoAfrican AmericanAsianWhite CaucasianOther
City where you live*
Family/Parent/Guardian Name*

First NameLast Name
E-mail*
Mobile Number*

Area CodePhone Number
My Products
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March Monthly Family Donation $100.00
March Monthly Family Donation

March IRC Reimbursement$100.00
IRC Reimbursement Payment for Recreational Services, Basketball, Dance, Karate, Soaring Eagles

Already donated this month / Self Determination$ Free
Please hit PayPal to check out. (Zelle - rocknourdisbilities@gmail.com)

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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