Adult/Guardian Name *

First Name

Last Name

Email Options

(We will never share, sell, or rent individual personal information with anyone. Information submitted to us is only used for purposes of contacting you based on your request for information)

Please send me information about classes to this email

I'd like to receive updates about classes, workshops, and performances from Word Dance Theater to this email

This is not an email that my family would like to be contacted at

Registering for:

Full 4-week session

Drop In Class

Student #1 Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Desired Class for Student #1 *

Tuesdays / 6:00 pm / Technique / Ages 13+ / Takoma / In Person

Student #2 Name

First Name

Last Name

Birthday

MM

DD

YYYY

Desired Class for Student #2

Tuesdays / 6:00 pm / Technique / Ages 13 + / Takoma / In Person

Authorization *

I authorize Word Dance Theater to use images of my child/children, including their face(s)

I authorize Word Dance Theater to use images of my child/children, but their face(s) may not be in the image

I authorize Word Dance Theater to use images of me, but my face may not be in the image

I authorize Word Dance Theater to use images of me, including my face

I do not authorize Word Dance Theater to use images of me or my child/children

How would you like to pay? *

Online (PayPal)

Check made out to Word Dance Theater

How did you find us? *

Friend

Neighborhood listserv

Takoma Park Folk Festival

Montgomery Co. activity guide

Flyer around Takoma Park

My child's school

N/A (Returning student)

Other

To finish registration *

(Specific information on how to pay is on the Registration Details page)

I understand that registration is not complete until payment is received. After clicking "SUBMIT" I will wait for the PayPal button to appear, then follow that link to online payment, or mail a check.