Outshine Dance & Fitness Registration Form

Outshine Dance & Fitness — Online Registration Form

   Please complete and submit the registration form below. Registration fee of $30.00 per family per year.
   *PLEASE NOTE: This is not a guarantee, only a request for a class.
   No class is confirmed until we check for availability. Your information will not be shared or distributed.

Name First Last
Email
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Work Phone - (###) - ### ####
Child #1 Name First Last
Child #1 Date of Birth
Class Requested
Date of Class
Time of Class
Child #2 Name First Last
Child #2 Date of Birth
Class Requested
Date of Class
Time of Class
Child #3 Name First Last
Child #3 Date of Birth
Class Requested
Date of Class
Time of Class
Emergency Contact First Last
Emergency Contact Phone - (###) - ### ####
Please list any medical conditions that we should be aware of:
Comments: