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Clogging Registration
For the 2025 - 2026 Clogging Season
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Email
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Your email
Name of person agreeing to and responsible for payment:
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Your answer
Registration Fee
There is a $15 for an individual dancer or $25 per family registration fee that can be paid by Venmo to:
@Dixie-Christopherson.
I give permission to allow pictures of my student to be put on the MidTown Cloggers website without specific names being mentioned.
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Address:
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Phone number:
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Please make sure this is a number that can receive text messages.
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Dancer 1 Full Name:
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Your answer
Dancer 1 Gender:
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Female
Male
Dancer 1 Birthdate:
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MM
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DD
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YYYY
Dancer 1 Grade:
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Dancer 1 Other activities:
Please include day of week and time
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Dancer 2 Full Name:
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Dancer 2 Gender:
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Male
Dancer 2 Birthdate:
MM
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DD
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YYYY
Dancer 2 Grade:
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Dancer 2 Other activities:
Please include day of week and time
Your answer
Dancer 3 Full Name:
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Dancer 3 Gender:
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Dancer 3 Birthdate:
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DD
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YYYY
Dancer 3 Grade:
Your answer
Dancer 3 Other activities:
Please include day of week and time
Your answer
Dancer 4 Full Name:
Your answer
Dancer 4 Gender:
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Female
Male
Dancer 4 Birthdate:
MM
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DD
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YYYY
Dancer 4 Grade:
Your answer
Dancer 4 Other activities:
Please include day of week and time
Your answer
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