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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 requests to ensure an instructor and the studio is available.

**Please ensure your date selections are on 3 DIFFERENT DAYS. If you provide 3 times on the same day, IT WILL NOT BE ACCEPTED. We want to ensure we have a selection of dates in case your first choice is unavailable**
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Hostess First & Last Name *
Phone: *
Email: *
What's the occasion? *
Type of Party *
How many people? *
Party guest 6 minimum ---- Pole: 14 max ----- Chair: 10 max ---- Combo: 10 max
Guest List: *
Please provide the first and last names of your party guests.
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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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, style or color scheme? What is the name of your Guest of Honor or group? Any song requests? Any additional information that may help us make your party special!
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