Class Information

Program: Zumba® Kids

Course: Course

Dates:
Jan 13,20,27
Feb 03,10,17,24
Mar 03,10,17,24
Class schedule:
Tuesday 3:15 PM - 4:15 PM (K -5th)
Cost: $280

School Information

School: Rainbow Christian School

Address: 22940 Old Dixie Hwy, Goulds, FL
Phone: (305) 258-0194

Student Information

First Name *

Last Name*

Grade *

Gender *

Classroom # and/or teacher name

Is your child enrolled in aftercare?*
Yes No

Specify any special needs if applicable

Parent Information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Phone Number*

Email Address*

Other Authorized Guardian

First Name

Last Name

Relationship

Phone

Emergency Contact

Same as parent information

First Name*

Last Name*

Phone*

Payment Information

Same as parent information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Card Information

Card Number*

Expiration Date*

CCV*

Important Stuff

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I have read and agree to the Waiver and Release.

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