November 7, 2026 Free Wellness and/or Dance Workshop Registration Form
Please complete the following form to register for the November 7, 2026 Free Wellness and/or Dance Workshop at Grace Congregational Church of Harlem, 310 W 139th Street, New York, NY 10030. You will receive an email confirmation from info@modartsdance.com. Please double check your Spam Folder.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which age group best describes you?
*
Please Select
Under 18
18-29
30-45
46-64
65+
If you are under 18, please provide your parent's name and cell phone.
Selection which workshop you are registering for:
*
Please Select
Wellness Workshop 12-1pm
Dance Workshop 1:30-3:30pm
Both workshops
Submit
Should be Empty: