Registration - Purple - The D.R.E.A.M. Center

Billing information

First name*

Last name*

Email*

We'll send your receipt and other important info to this email.

Country

Address*

Address line 2 (optional)

Zip code*

City*

State*

This product is for someone else

Student info

Parent Name - First name*

Parent Name - Last name*

Parent Cell Phone

Parent Cell Phone*

Parent Email*

Home address

Country

Address*

Address line 2 (optional)

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) *

How did you hear about us?*

Acceptance

This is a gift

When would you like this gift to be delivered at?

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

Personal note to the gift recipient (optional)

If you want them to know who it's from, tell them here.

How many students?

Quantity

Your payment

Your price

Registration Fee
$15

Coupon code

ADD: Purple • Tue • Hip Hop • 6:30pm