Northern PG ZUMBA Dance Party Registration 2012

Girl Scout ZUMBA Registration, September 22, 2012

17% of survey complete.

Please complete this short registration for your daughter to participate in the Girl Scout ZUMBA Dance Party. You will receive a confirmation e-mail with additional information once you've completed the registration.

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* 1. Child's First Name

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* 2. Child's Last Name

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* 3. Child's Age

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* 4. Child's Date of Birth

Date of Birth

Date

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* 5. Child's Address

Address: *

Address 2:

City/Town: *

State: *

ZIP: *