Holiday Dance Clinic

Online registration is not complete until payment has been successfully processed.

"*" indicates required fields

Please enter a number from 1 to 2.
You can register two kids per form entry. If you need register more, you will need to complete the form again. Registration fee is $35 per child.
You can register two kids per form entry. If you need register more, you will need to complete the form again.
Child's Name 1*
Child's Name 2
Medical Treatment Authorization*
In case of medical emergency, I hereby give permission for the staff of DPHS to seek medical treatment for my child and give permission to medical personnel to administer treatment, if deemed necessary. Check box to authorize.
Type your first and last name in this box. This will serve as your "online" signature when the form is submitted.
Parent/Guardian Name:*
Address*
Email*
Photo Release (Must be checked to attend)*
Internet Use (Must be checked to attend)*
You will be redirected to PayPal to complete payment when you submit this form.

 

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