Neon Nights Glow Dance Registration
Friday, March 24 from 6PM to 8PM
AO School Gym
2832 N NC Hwy 87, Elon, NC
Contact us at aopta2013@gmail.com

Please fill out ONE form per child. Thank you!
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Email *
Student's First Name *
Student's Last Name *
Teacher Name *
Grade Level
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Emergency Contact Name *
Emergency Contact Phone Number *
Number of Parents or Guardians Attending *
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Parents and/or guardians are responsible for their student and MUST agree to the terms below. *
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Please type your name below to digitally sign this registration form. A copy will be emailed to you at the email address that you provided. *
A copy of your responses will be emailed to the address you provided.
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