YDP Trial Class Form 2024-25 – José Mateo Ballet Theatre

PARENT NAME

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Last

STUDENT NAME

First

Last

EMAIL

Email

Confirm Email

DATE OF BIRTH

PHONE

PREFERRED LOCATION

Cambridge
Dorchester

DOES YOUR CHILD HAVE PRIOR DANCE EXPERIENCE?

Yes
No

PLEASE DESCRIBE YOUR CHILD'S PRIOR DANCE EXPERIENCE.

PAYMENT INFORMATION

TRIAL CLASS FEE

Price: $25.00

TRIAL CLASS CODE

WAIVED TRIAL CLASS FEE (DOTNEWS)

Price: $0.00

WAIVED TRIAL CLASS FEE (STORYTIME)

Price: $0.00

WAIVED TRIAL CLASS FEE (PATCH25)

Price: $0.00

WAIVED TRIAL CLASS FEE (MOMMYPOPPINS25)

Price: $0.00

WAIVED TRIAL CLASS FEE (BOSTONMOMS25)

Price: $0.00

WAIVED TRIAL CLASS FEE (CCC25)

Price: $0.00

WAIVED TRIAL CLASS FEE (NUT25)

Price: $0.00

NAME ON CARD

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Last

CREDIT CARD INFORMATION

Card Number

Expiration

/

Security Code

BILLING ADDRESS

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country