Kansas City Dynamites Registration

Dynamites Registration
Child Name

First Name Last Name
Birth Date *

Month Day Year
School Name
Grade Level

K-3rd 4th-6th 7th-12th
Any Dance Experience

Yes No
Parent Name *

First Name Last Name
E-mail *
Phone Number

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Should be Empty: