Moments Unforgettable Registration
Registration form
Email address *
Student Name *
Your answer
Student's Birthday
MM
/
DD
/
YYYY
Phone Number *
Your answer
Parent's Name (if student is a minor) *
Your answer
Home Address
Your answer
Emergency Contacts (Name and ph#)
Your answer
Please check the box to confirm that you've read and agree to the Waiver of Liability and the Media Release. *
Required
REMINDERS:
1. Please update our staff if any of the above information changes.
2. If you are unable to make a class, please call/text/email the teacher beforehand.
3. Remember to pack water for class and dress comfortably.
Select the class(es) that are registering for: *
Required
Class Prices
Drop-In Rate for any class $15 Sibling Discount $12

Monthly Tuition $45 Sibling Discount $40

Dance Class Card $115 (good for 10 classes)


PAYMENTS:
Checks written to MOMENTS UNFORGETTABLE
PayPal (friends and family) to kumulehua@gmail.com
Cash payments in person

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service