Culture Block Free Dance Class Registration

Charlotte Ballet

Please complete the registration information below. Upon completion of the survey copy the zoom link(s) and password for the classes of your choice.

The meeting links at the end of this survey will be for classes January 12-14, 2021.

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* 1. Registrant Information

First Name

Last Name

Address:

City

State

Zip Code

Phone Number:

E-mail address:

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* 2. Ethnic Background

Asian

Black/African

Caucasian

Hispanic/LatinX

Native American

Pacific Islander

Prefer not to asnwer

Mixed

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* 3. What is your age range?

0-18

19-35

36-50

51-65

65-100

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* 4. Please select the classes you are registering for this week.

Senior Adult Dance- Tuesday 1-2 PM

Latin Dance- Tuesday 6-7 PM

West African Dance- Wednesday 5-6 PM

Senior Adult Dance- Thursday 10:30-11:30 AM

Therapeutic and Inclusive Dance Class-Thursday 5-6 PM

Jazz Dance-Thursdays 7-8 PM