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)

YesNo

How did you hear about Empowering Steppers?*

Parent Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

YesNo

FacebookInstragramTik TokNone

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

TextEmail( comes from empoweringsteppers@gmail.com)Both

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

Youth Name #1 *

First NameLast Name

Date of Birth*

MonthDayYear

Age*

Current School Name *

What is your grade level?*

YesNo

What is your child's social media name? If doesn't apply type N/A*

Child Personal Number*

Format: (000) 000-0000.

YesNo

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

Youth Name #2

First NameLast Name

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

Date of Birth

MonthDayYear

Age

Current School Name

What is your grade level?

YesNo

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

Child Personal Number

Format: (000) 000-0000.

YesNo

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

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

Registration fee is $50 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

Cash

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. Please note that your child spot is not secured until payment has been received.

You will soon receive an invitation to join the GroupMe “StepFam Connection”—a chat for future steppers, parents, and leadership. Through this group, you’ll get important updates and information during this exciting journey to becoming an official Empowering Steppers Step Team (ESST) family member!