Zoho Creator- Registration Form

Registration Form

Class Data

Preview class *
Tots - FREE Class (w/ paid admission) - Fri. 11/20, 10:15 -- Kidzu Children's Museum: 105 E Franklin St 27514
Tots - FREE Class - Sun. 11/22, 04:00-- Barnes & Noble at Southpoint Mall 27713
Kids - FREE Class - Sun. 11/22, 04:45-- Barnes & Noble at Southpoint Mall 27713
Babies - FREE Class - Tue. 11/24, 10:30a-- Welcome Baby: 721 Foster St Durham 27701
Tots - FREE Class - Mon. 11/30, 10:30 - 11:00 am -- Parkwood Library: 5122 Revere Rd 27713
Tots - FREE Class - Tue. 12/01, 10:30 - 11:00 am -- Parkwood Library: 5122 Revere Rd 27713
Tots - FREE Class - Mon. 12/14, 10:30 - 11:00 am -- Parkwood Library: 5122 Revere Rd 27713
Tots - FREE Class - Fri. 01/08, 09:45 - 10:15 am -- Stage Door Dance: 2720 Godley Ln #101 27617
Babies - FREE Class - Fri. 01/08, 10:30 - 11:00 am -- Stage Door Dance: 2720 Godley Ln #101 27617
Kids - FREE Class - Tue. 01/19, 10:30 - 11:00 am -- Parkwood Library: 5122 Revere Rd 27713

Personal Data

Name *

Child 1 Name *

Child 1 Date of Birth * [MM-dd-yyyy]

Child 2 Name

Child 2 Date of Birth [MM-dd-yyyy]

Child 3 Name

Child 3 Date of Birth [MM-dd-yyyy]

Phone
(9991234567) *

Mobile Phone
(9991234567)

Email Address *

Street Address *

City *

State *

Zip Code *

Comments

Waiver
Please read the waiver link and check the box below to agree to the terms and conditions of the waiver.

I have read, understood and agree to the terms and conditions stated in the waiver above *

Referral

How did you hear about
Salsa Babies/Tots/Kids? *

Verification
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Verification Code

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