"*" indicates required fields Step 1 of 2 50% Dance Class x5 Price: PERSONAL INFORMATIONStudent's School* Name* First Last Student's Age* Parent's Name* First Last Parent / Guardian's Email (Primary Email Address for all communications to/from Jaxx Theatricals)* Parent / Guardian's Phone Number*Address* Street Address City ZIP / Postal Code Lessons*Please select your three best options for the lesson(s). Mondays 3-4PM Mondays 4-5PM Mondays 5-6PM Mondays 6-7PM Mondays 7-8PM Mondays 8-9PM Tuesdays 3-4PM Tuesdays 4-5PM Tuesdays 5-6PM Tuesdays 6-7PM Tuesdays 7-8PM Tuesdays 8-9PM Wednesdays 3-4PM Wednesdays 4-5PM Wednesdays 5-6PM Wednesdays 6-7PM Wednesdays 7-8PM Wednesdays 8-9PM Thursdays 3-4PM Thursdays 4-5PM Thursdays 5-6PM Thursdays 6-7PM Thursdays 7-8PM Thursdays 7-8PM Thursdays 8-9PM Fridays 3-4PM Fridays 4-5PM Fridays 5-6PM Fridays 6-7PM Fridays 7-8PM Fridays 8-9PM Saturdays 9-10AM Saturdays 10-11AM Saturdays 11AM-12PM Saturdays 12-1PM Saturdays 1-2PM Saturdays 2-3PM Saturdays 3-4PM Saturdays 4-5PM Saturdays 5-6PM Saturdays 6-7PM Saturdays 7-8PM Saturdays 8-9PM Sundays 9-10AM Sundays 10-11AM Sundays 11AM-12PM Sundays 12-1PM Sundays 1-2PM Sundays 2-3PM Sundays 3-4PM Sundays 4-5PM Sundays 5-6PM Sundays 6-7PM Sundays 7-8PM Sundays 8-9PM Any extra information we should know? Are you comfortable with your child performing maskless? Please explain stipulations, if needed.* FINANCIAL INFORMATIONCredit CardPlease check if you have activated a Stripe feed for your form. Coupon Total CommentsThis field is for validation purposes and should be left unchanged.