Course Registration Form

Course Registration Form

Please fill out the form below to register for the course.
Parent's Guardian *

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Student Full Name

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Select Your Course

Kids class on Saturday 6pm-7pm - 65$Adults class on Sunday 5pm-6pm - 65$Drop-In class - 20$
Payment:

E-transfer to solongocontortionstudio.scs@gmail.comCashCheque
Gender

MaleFemaleOther
Phone Number
Please enter a valid phone number.
Would you like to receive updates and notifications?

Yes, I want to receive updates.No, thank you.
Signature to confirm the registration*

Clear
Should be Empty: