2026 Empowering Steppers Interest Form

Calling all Raleigh, NC and surrounding Triangle FamiliesNo experience is required Everyone is taught the art of stepping

Thank you for your interest in Empowering Steppers. Please make sure we have your correct email and contact number for all communication. More information will be sent to all parents. If you have any questions please send email to empoweringsteppers@gmail.com or text 973-573-6704

Don't forget to follow us on our social media pages

Facebook: Empowering Steppers
Instragram: Empowering Steppers
Tik Tok: esst15
Youtube Channel: empoweringsteppers15 (like and subscribe)

Do you know anyone apart of Empowering Steppers?*

YesNo

How did you hear about Empowering Steppers?*

Parent Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Do you(parent) have an Instagram/ Facebook/ Tik Tok account?*

YesNo

Which of the below social media accounts do you(parent) have?*

FacebookInstragramTik TokNone

What is your(parent) Facebook, Instragram and Tik Tok name?*

How would you prefer to receive information?*

TextEmail( comes from empoweringsteppers@gmail.com)Both

Youth Name #1 *

First NameLast Name

Date of Birth*

MonthDayYear

Age*

Current School Name *

What is your grade level?*

Do you have an Instagram/ Facebook/Tik Tok account?*

YesNo

What is your (stepper) social media name? If doesn't apply type N/A*

Can your daughter participate in a group text chat? We will be sending videos of basic team drills and a simple step for her to learn. This will give us an idea on the level of training your daughter will require. Again, no experience is needed because everyone will be taught the art of stepping.*

Yes (Please make sure her number is listed below)No

Child Personal Number*

Do you have any step, cheer or dance experience?*

YesNo

Youth Name #2

First NameLast Name

Date of Birth

MonthDayYear

Age

Current School Name

What is your grade level?

Do you have an Instagram/ Facebook/Tik Tok account?

YesNo

What is your (stepper) social media name? If doesn't apply type N/A

Can your daughter participate in a group text chat? We will be sending videos of basic team drills and a simple step for her to learn. This will give us an idea on the level of training your daughter will require. Again, no experience is needed because everyone will be taught the art of stepping.

Yes (Please make sure her number is listed below)No

Child Personal Number

Do you have any step, cheer or dance experience?

YesNo

Please explain your experience including team name (this information will not be shared or discussed) If this doesn't apply type N/A*

Does your child have any medical conditions, allergies, or injuries we should be aware of? If none type N/A*

What are you hoping to get out of stepping or being a part of Empowering Steppers?*

Registration fee is $40 per protential stepper and can be paid via the following payment options.

CashApp: $esst15 (Type child's name in the "FOR" selection)account name is under Tameka Campbell

Venmo: @esst2015

Apple Pay: 919-219-1944
Zelle: 973-573-6704

Reminder: Registration fees are non-refundable which is due once the parent informational meeting is completed. This secures your daughter's spot

In person meet and greet interest meeting will be scheduled soon.