Language
English (US)
VPNB Dance Class Registration
Winter Semester - January 9 - February 27, 2021
1st Student Name
First Name
Last Name
Age
2nd Student Name
First Name
Last Name
Age
Parent/Guardian Name (if student is under 19 years of age)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Select Class Type
Beginner/Intermediate 5-7 yrs old 10:00am-11:00am
Beginner/Intermediate 8 - 11yrs old 11:00am-12:00pm
Beginner/Intermediate 12yrs + 12:00pm - 1:00pm
Payment
*
prev
next
( X )
Dance Class 5 -7 yrs
$
150.00
CAD
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
CAD
Dance Class 8 - 11 yrs
$
150.00
CAD
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
CAD
Dance Class 12 yrs +
$
150.00
CAD
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
CAD
Enter coupon
Apply
Total
$
0.00
CAD
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
SUBMIT*
*By submitting your registration you agree to our terms and conditions as outlined below.
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm