Trapeze Class Registration

Trapeze Class Registration

Please fill in the form below to secure your spot.
Full Name*

PrefixFirst NameLast Name
Name you go by (if different from name above):
E-mail*
Phone Number*

Area CodePhone Number
Emergency contact name, relationship to you, and phone number:*
Which class?

Advanced Beginning Dynamic Trapeze (Thurs, 5:30-6:30pm)Intermediate/Advanced Dynamic Trapeze (Thurs, 6:30-7:30pm)Beginning Dynamic Trapeze (Tues, 6-7pm)
Any notes you would like to share with the instructor:
CLASS LOCATION: Madison Circus Space, 2082 Winnebago Street, Madison, WI 53704
Cost: $165 for six-week series
Pay via check (to Head Over Wheels), PayPal (to thenarr@gmail.com), or Venmo (to Carly-Schuna) on or before the first day of class
Should be Empty: