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Rebel Party Request Form
Please fill out the following form in order to inquire about booking a party. We require 2 weeks notice for party request to ensure an instructor and the studio is available.
Email address *
Hostess First & Last Name *
Your answer
Phone: *
Your answer
Email: *
Your answer
What's the occasion? *
Type of Party *
How many people? *
Pole: 14 max ----- Chair:10 max ---- Combo:10 max
Your answer
Guest List: *
Please provide the names of your party guests.
Your answer
Date Option 1: *
Please provide your first choice of party date and time.
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Date Option 2: *
Please provide a second choice party date and time, different from date option 1
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Time
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Date Option 3: *
Please provide a third option party date and time, different from options 1 and 2
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Time
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Dance Style: *
Pole Dancing is a great way to have fun and let loose with your friends. The dancing style can be anywhere from cute and flirty to exotic club style. Please choose the level of sassiness that you'd like for your party below.
Music Style: *
Additional Information *
Is there a theme or style? What is the name of your Guest of Honor or group? Any additional information that may help us make your party special!
Your answer
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