Fall Ballet 2019 Registration
Please contact Emily Hefley at emily@gpacweb.com or 751-7665 for questions on class placement.
Child First Name *
Your answer
Child Last Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Name of Parent(s) *
Your answer
Address *
Your answer
City, State, Zip *
Your answer
Primary Email (used for all email communication) *
Your answer
Primary Phone Number *
Your answer
Please select an available class below *
Does your child have any medical condition or learning disability that the instructor should be aware of? All students will sign a GPAC liability and media release form on the first day of class. *
This information will help instructor/staff to better instruct your child.
Your answer
Method of Payment *
There is a $25 deposit due at the time of registration in order to hold your space. The balance less the deposit will be due on the first day of class. Please inquire if a payment plan is needed. Payment can be made online at www.mkt.com/gpac
Submit
Never submit passwords through Google Forms.
This form was created inside of City of Germantown. Report Abuse - Terms of Service