Sureela 2019 Fall Registration
Student Name *
Your answer
Student Date of Birth *
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DD
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YYYY
Student Phone Number (if applicable)
Your answer
Student Email (if applicable)
Your answer
Guardian Name (if under 18)
Your answer
Guardian Phone Number (if under 18)
Your answer
Guardian Email (if under 18)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Email *
Your answer
Student Home Address *
Your answer
Does the student have any allergies or existing medical conditions? *
Your answer
Does the student already have a Kathak Handbook? *
Does the student already have Manjira? *
Would you be interesting in carpooling to classes and/or events?
Your answer
Are you interested in getting more involved with Sureela? (Fundraising, event planning, volunteering, etc.)
Your answer
I understand that my tuition payment is due on the first day of class - September 29th. *
I would also like to attend the Thursday Technique & Stamina class 6-7pm and understand that this tuition payment of $120 is also due on the first day of class - September 29th.
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