Private Lesson Registration Form
Let us know how we can help you!
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Dancer’s Name
*
First Name
Last Name
What would you like to work on?
*
Choreography
Technique/Execution
Stage Presence/ confidence
Career/Mentorship
Majorette Agilities
Strength & Conditioning
Other
Specific focus areas for training
*
Any medical, allergies, previous injuries we should be aware of?
*
Appointment
Any other specific date and time, if the above selection is not suitable.
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Serivices
*
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( X )
1 Hour Session- Director B
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
1 Hour Session: Coach Kaylee
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
1 Hour Session - Coach Destiny
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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