Rising Stars: Triple-Threat!!! (grades 5-8) Registration Form
Questions? E-mail Mrs. T. at hiphoptelestai@gmail.com
Child's First & Last Name *
Your answer
Grade Level *
Required
Adult 1 Name *
Your answer
Adult 1 E-mail *
Your answer
Adult 1 Phone *
Your answer
Adult 2 Name
Your answer
Adult 2 E-mail
Your answer
Adult 2 Phone
Your answer
Any health or learning notes for Mrs. T.? (asthma, diabetes, allergies, ADHD, autism spectrum, etc.)
Your answer
I acknowledge that this class carries a certain amount of risk, as would any movement activity. In the event that my child should be injured, I assume all responsibility and will not hold Kerith Telestai liable. *
I give my permission for my child to be photographed/recorded without his/her name attached for the purposes of promoting this program. *
Your registration is not complete without payment. Tuition cost of $195 covers all 8 days. Please pay Kerith Telestai through the Venmo app (venmo.com/app) in order to secure your child's place. (No fee if paid with your Venmo balance, debit card, or bank account; 3% fee if paid with credit card.) Unpaid registrations will be moved to a waitlist after 24 hours. Thank you! :)
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