Hoboken Dance Online Registration Form
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Child's First Name
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Child's Last Name
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Parents First Name
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Parent's Last Name
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Street Address
Address Line 2
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City
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Zip Code
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Phone Number
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Email Address
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Child's Birthday
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Emergency Contact Name and Phone Number
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Release of liability: I, as the legal parent or guardian of the above student,
Authorize his/her enrollment in the above classes and release the Hoboken
Dance Academy, LLC of all liability due to personal injury or loss of property.
Signature
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Class Choice- Day -Time
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Payment Number
Registration fee $25.00
Discount if applicable (
HFA Members 20% discount and 10% Sibiling discount
)
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Total
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Payment Method
Check
Cash
Credit Card
Name on Card
Credit Card Type
Visa
MasterCard
American Express
Credit Card Number
CSC Code
Expiration Date (mm/yy)
Things we should know about your child
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Indicates Response Required
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