Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone *

Email *

Student Name *

Date of birth *

I understand full payment is required for registration. Partial refunds will be considered up to 20 days after purchase. I am aware that I am registering for this class at my own risk. I will not hold A Dance for Life Movement and Healing Arts, Movement & Healing Arts LLC, or the property owners liable for any injury or damage that may occur during the classes.