Introductory Kathak Workshop Registration
Student Name *
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Student Date of Birth *
MM
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DD
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YYYY
Student Phone Number (if applicable)
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Student Email (if applicable)
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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 *
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Emergency Contact Phone Number *
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Emergency Contact Email *
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Student Home Address *
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Does the student have any allergies or existing medical conditions? *
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Workshop fee - $10 *
Are you considering pre-registering for the fall semester at Sureela at the end of the workshop to get a $15 discount on tuition? If so please have your tuition fee of $195 (regularly $210) payable via cash or check!
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