The Dance Corner Killingworth, CT: Register

Childs Name:
Childs Birthday:
Parents Name:
Street:
City:
Zip Code:
Phone:
Emergency Contact:
Emergency Phone:
Register for Classes: Please Note: Enter class #'s like 9, 15, 17, etc.
Register for Workshops, Camps:	Note: If you are registering for Try-It Day, please indicate your choice of class time and style in the box below.
Notes: (Any important/medical information that we shouldbe aware of)
Session:
Email:	(E-mail)
I will Pay: (We will call you for your credit card number.)	Monthly by Bill Monthly by Credit Card Semi-Annual by Check Semi-Annual Credit Card
Policy Acceptance:	I have read and understand The Dance Corner, LLC’s policies, and do hereby release from all liability The Dance Corner LLC, its staff and contractors for any and all injuries sustained during the course of dance or dance related study.
Security Code:	To help us distinguish between information submitted by individuals and that which is automatically entered by software robots, please type the characters shown into the box below.