subject_line
BOOK YOUR FREE TRIAL HERE
Students First Name:
*
Students Last Name:
*
Students D.O.B:
*
(Note: If booking free trial for the new parent and child class please put the name and date of birth of the child attending above and the parent attending as the emergency contact details below)
Contact Email Address:
*
Mobile Number (if under 16, this must be the number of the parent / guardian):
*
Emergency Contact Person Details
*
Medical conditions (please type 'NONE' if none):
*
Is there a particular class you'd like to attend or perhaps a certain day you'd prefer (please refer to our
timetable
to answer)?
Note: Monday 4:35pm age 6 to 9 class and Tuesday 8:30pm adult intermediate class are currently full, you can still apply here to be added to the waiting list.
How did you hear about Hip Hop Pop?:
Facebook
Google
Word of Mouth
At a Performance
Through a School
Other
Your consent is needed...
Select
YES
below, so you don't miss out on Hip Hop Pop's events and activities, plus all our latest news by saying YES to receiving our email updates.
*
Yes
No
Please sign to confirm you've read, understood and agree to the
terms and conditions
and that you've had the chance to read and understand our
privacy policy
.
*
clear