Individual Registration

Please enter information in the form below to process registration for event Greystones street dance lunch time club Wednedays Years 3/4 ONLY.

Parent First Name *

Parent Last Name *

Child's Full Name *

Address *

Address 2

City *

Postcode *

Country *

Contact Number *

Email *

Medical Conditions

Child's Year Group *

Safeguarding

Allow to walk home

Will be collected

Amount

Payment Method

Stripe

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*