Parent 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 updates about classes to this email

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

Child #1 Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Desired Class for Child #1 *

Tuesdays at 3:00 pm / Duncan dance, ages 5-7

Tuesdays at 4:00 pm / Duncan dance, ages 8-10

Tuesdays at 4:30 pm / Duncan dance, ages 11+

Wednesdays at 3:00 / RainbowDance, ages 1-4

Child #2 Name

First Name

Last Name

Birthday

MM

DD

YYYY

Desired Class for Child #2

Tuesdays at 3:00 pm / Duncan dance, ages 5-7

Tuesdays at 4:00 pm / Duncan dance, ages 8-10

Tuesdays at 4:30 pm / Duncan dance, ages 11+

Wednesdays at 3:00 / RainbowDance, ages 1-4

Authorization *

We would like to take a few SCREENSHOTS of a live class and will announce before taking the picture. These are primarily for grant applications and board reports, but please indicate below your authorization for publishing or printing, if an opportunity should arise. If it does, all families will be notified and asked before publishing/printing.

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

How would you like to pay? *

Online (PayPal)

Check 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.