Hip-Hop Music Lessons Enrollment Form

Thank you for your interest in joining our Hip-Hop Music Class! Please fill out the form below to complete your registration.

Student Information

First Name

Last Name


Date of Birth

Gender

Street Address

City/Suburb

State/Province


Postal/Zip Code


Phone Number

Email Address


Parent/Guardian Name (if under 18)

Emergency Contact Name


Emergency Contact Phone

Class Preferences

Class Type

Preferred Days (Please check all that apply)

Preferred Time (Please check all that apply)

Class Duration

Are you interested in group or private lessons?

Hip-Hop Experience

Do you have prior experience with Hip-Hop music or dance?

If yes, please describe your experience

What are your goals for this class? (Please check all that apply)

Payment Information

Monthly Fee

$0.00

Payment Method

Waiver and Agreement

I understand that participation in this class involves physical activity and I am responsible for my own safety.

I grant permission for photos/videos taken during class to be used for promotional purposes.

I have read and agree to the terms and conditions outlined by [Organization Name].

Signature

Student/Parent Signature

Additional Notes or Special Requests


Thank you for registering! We look forward to seeing you in class!


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