Wee Rockers Enrollment Form (Jan 2019 start)
Please complete and return this form to enroll in the Wee Rockers program. To pay online, using any credit card or PayPal, please go to studionoir.rocks and scroll down until you see the "PAY NOW" button beneath our Wee Rockers flyer. If you prefer to pay in person, please bring cash, check or credit card to the first day of class.

Feel free to call/text Sammi at 516-476-2473 with any questions. Thank you!
Email address *
Please select class dates *
Child's Name *
Parent's Name *
Cell number *
Email *
Address *
Child's Birthday *
Additional Emergency Contact Name and Number *
I realize that my child(ren) may be photographed or recorded. Photos and videos may be published on the Studio Noir website or Facebook page, or for informational and/or marketing purposes regarding programs at Studio Noir. I give permission for photos and/or videos to be used. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy