Hip Hop Master Class Flyer Registration Combo.pub

Anthony Lofendo has
worked with artists such
Will.I.Am, Katy Perry,
many more! He’s been
featured in film (This is
the End) and television
(GLEE). His charismatic
personality and extensive knowledge makes
him highly sought after
in the world of dance.
APAC Hip Hop Master Class Registration Form
Please fill out the form below and return with full payment to: APAC 1049 Industrial Blvd, Ste 200 Abilene, TX 79602
You will receive an email confirmation once this form and payment are received.
One registration form per student please. We accept CASH or CHECK payments. Checks payable to APAC.
Please check the appropriate Wednesday, May 20th Hip Hop Master Class:
3rd-5th Grade 4:00-5:30 p.m.
6th & Older 6:00-7:30 p.m.
Student Name: ___________________________________ Age: ____ Current Grade: ____
Parent/Guardian Name: ___________________________________ Contact Number: ________________
Parent/Guardian Email Address: _________________________________________________
Student is currently enrolled in an APAC class:
__Yes __No
If yes, which class? ___________________
Payment Information (Payment is non-refundable):
__ 2014-2015 APAC Student Cost - $25 per student
__ Non APAC Student Cost - $35 per student
__Cash __Check ______Check Number
$_______Payment Total
I hereby allow APAC to take photographs of my child to be used for public relations and archival purposes. __Yes __No
By signing below, I understand that APAC, its staff and Board of Directors are not responsible for accidents that may occur before, during or after
this APAC Master Class. I also understand that the payment I have made is NON-REFUNDABLE.
Parent/Guardian Signature ________________________________________
Date _____________