Class Information

Program: Zumba® Kids

Course: Course K- 5th

Dates:
Jan 07,14,21,28
Feb 04,11,18,25
Mar 04,11
Class schedule:
Wednesday 3:45 PM - 4:45 PM (K -5th)
Cost: $200

School Information

School: Beachside Montessori

Address: 2230 Lincoln St, Hollywood, FL
Phone: (754) 323-8050

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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