Lilac Registration Package [SAT]

Billing information

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Last name*

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This product is for someone else

Student info

Parent Cell Phone

Parent Cell Phone*

Parent Email*

Home address

Country

Address*

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Zip code*

City*

State*

Dancer First Name*

Dancer Last Name*

Dancer's Birth Date*

Dancer's Gender*

Does your child have any medical conditions?*

Additional information we should know about your child and/or family?*

Emergency Contact(s) *

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This is a gift

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Time zone: (GMT-05:00) Eastern Time (US & Canada)

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Package
$15 + $199 on 1 Jun 2023 ($214 total)

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Update

INCLUDED: Lilac • Sat • Ballet • 10:15am

INCLUDED: Lilac • Sat • Tap • 10:45am

INCLUDED: Lilac • Tue • Jazz/Hip Hop • 11:15am

Schedule of payments

Due	Amount
Today	$15.00
Jun 1	$199.00

Today	$15.00
Jun 1	$199.00

Stripe

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