Register Rise-Dance Class for differently-abled.

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* 1. Please Enter Your Contact Information Below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. If you are a parent registering for a child or children, please enter names and age below.

Child's Name

Child's Ages

Special Considerations: i.e. wheelchair, crutches

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* 3. If you are a caregiver registering for an adult, please enter names and age below.

Adult's Name:

Adult's Age:

Special Considerations: i.e. wheelchair, crutches