Dance Cirque Introductory Workshop

• C$0

  Total

• Please indicate student age group: *
  Please indicate student age group:

  Student aged 6-8 Student aged 9-11
• Student's Name:

  Student's Name: * First Last
• Student's date of birth:

  Student's date of birth: * / MM / DD YYYY

  
• Student's current age: *
• Parent/Guardian's name:

  Parent/Guardian's name: * First Last
• Parent/Guardian's Phone number:

  Parent/Guardian's Phone number: * - ### - ### ####
• Parent/Guardian's email address: *
• AGES 6-8. Please select one option: *
  AGES 6-8. Please select one option:

  I would like my child to participate in the two-day workshop (June 20th & 21st) for $75.00 I would like my child to participate in the one-day workshop (June 20th) for $40.00
• AGES 9-11. Please select one option: *
  AGES 9-11. Please select one option:

  I would like my child to participate in the two-day workshop (June 20th & 21st) for $85.00 I would like my child to participate in the one-day workshop (June 20th) for $45.00

• C$0

  Total