Mojuba! Center for Dance and Culture Registration Form-Mojuba! Dance

First name

Last name

Email

Phone Number

How did you hear about us?

Friends

Social Media

Other

Are you registering yourself or your child(ren)?

Myself

My Child(ren)

If you are registering your child(ren), please provide their full names and ages below

Please provide an emergency contact's name, phone number, and relation to you

Please provide the names and phone numbers of those person authorized to pick up you child(ren), if applicable

I want to subscribe to the mailing list.

For which Session are you registering yourself or your child(ren)?

Youth Summer Cultural Arts Camp - July 15 - 19th

Summer Intensive - July 29th - Aug 2nd

Please share any allergies to food or environment of which we should be aware.

Are you interested in before and/or after care?

Yes

No

I confirm that all the above information is correct and I have submitted my registration fee

Mojuba! Center for Dance and Culture Registration Form