COREdination Pilates. "Strength to the Core"

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Directions:

Please fill out the form below. Include the names of additional family members registering at this time and their date of birth in the Family Member/class name below. Please then add the specific additional classes and the preferred class times in the Question/Comment section. Please make sure that it is clear what family member is registering for what classes.

If you wish to pay the year in full, please enter that into the notes section below. All students who pay for the season in advance will receive a 5% discount.

Please schedule carefully as there are no reimbursements.

Select Class:

Preferred Day/Time:

Student's First Name:
Student's Last Name:
Student's Current Age:	years
Student's Birthdate:	(MM/DD/YYYY)

Parent's First Name(For students under 18 only):
Parent's Last Name:(For students under 18 only):
Address Line 1:
Address Line 2:
City:
State:	Zip Code:
Email Address:
Home Phone Number:	- -
Work Phone Number:	- -
Cell Phone Number:	- -

How did you hear about us?:
Other:

Please enter the names of additional family members now registering and their date of births.
Additional Family Members/ Date of Birth:

Previous Experience:

Question/Comment:

Dance Fusion

(330) 659 - 0030

amdancefusion@yahoo.com