DANCEBOX JUNIORS

Name: Dance Box Studios
Address: 216 - 218 Regency Court Upper Fifth Street, Milton Keynes, MK9 2HR, GB
Telephone: 01908 672 920

CLASS REGISTRATION FORM

Parent First Name

Parent Last Name

Parent Email

Parent Phone

Child First Name

Child Last Name

Child Date of Birth

Child School Year

Child Medical Conditions / Allergies / SEN

Please select the class(es) that your child will attend

Name on Payment Card

Long Card Number

Card Expiry Date (MMYY e.g. 0127)

Address Card is Registered (including door number and postcode)