Culturas en Movimiento Program                      Registration '24 - '25 Year
Thank you for your interest in the Culturas en Movimiento Program at Embodyment Wellness Studio!
By now you have reviewed our class information in our website (https://www.embodymentwellness.com/youthclasses). CLASSES START FEBRUARY 2025! 

Complete this form to begin the registration process. 
*New students: Once you enter our system to make a payment you will be asked to input your child's name and information!  Included in this process will be an electronic waiver form! Your child will not be able to participate without this form signed by their parent/guardian.

*Returning students will not need to fill out another waiver form. 

If you have more than one child registering, please complete an additional form (one form per child). Feel free to contact us by email at santina@embodymentwellness.com or call us at 223-667-3135 if you have any questions. 

Please complete all of the questions in this form and click SUBMIT at the end. Your registration will not go through until you click SUBMIT at the end of this form. Please note that a registration fee of $60 is also required before your child is officially registered. If you need financial assistance, Please reach out to Santina at  santina@embodymentwellness.com or call us at 223-667-3135.

We look forward to having you and your family a part of our dance family!
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Email *
Email *
Parent/Guardian Name: 
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Parent/Guardian Email:
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Parent/Guardian Phone Number:
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Have you previously had a child(ren) enrolled at  Embodyment Wellness Studio?

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Child Dancer Name
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Child Dancer Date of Birth
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Select the class/dance style(s) your child is interested in joining!  **Please check all that apply. 
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Does your child have a sibling who is also registering? (If yes, please complete and additional form)
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Emergency Contact Info (name, cell & relation to child)
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Are you willing/able to download the free app, "WHATSAPP" on your phone to receive important class information & communication? 
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Does your child have allergies (environmental/food)?    YES or NO   If yes, please list below.
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Tuition: Is due the 15th of every month, if you need financial assistance, please contact us for more information. 
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Does your child have any physical challenges or special needs?    YES or NO   If yes, please list below.
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Do you have any questions about our Youth Program?
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