Parent/Guardian Name

First Name

Last Name

Email Address

Phone Number

Student Name

Student Age

Student must be between 2-6 years of age to participate.

Preferred Pronouns

Who is the parent/guardian/care taker who will be accompanying your child to class?

Which free sample class would you like to attend?

We have a maximum capacity of 12 students for each Little UpBeats class.

Friday, October 24 - 9:30-10:00am

Wednesday, October 29 - 9:30-10:00am

Comments

Confirmations and a waiver will be sent via email within 2 business days of submission of this form.

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