Class Registration

LIMELITE reserves the right to reschedule or cancel any classes that do not fill. If we are not able to place you in another class, you will receive a full refund.

Student's Name (Please register each child separately)
Parent's Name
Email Address
Home Phone
Mobile Phone
Home Address
Student's Date of Birth
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dd/mm/yyyy - You must enter 2 digits for day, 2 digits for month and 4 digits for year. Example: 01/22/2002
Emergency Contact Information ?
Name, Phone Number and Relation of Emergency Contact
Classes Desired, Day and Time ?
Classes Desired, Day and Time
Please list any information that we may need while in care of your child: allergies, asthma etc. ?
Please list any information that we may need while in care of your child: allergies, asthma etc.
Would you like to Refer a friend?
By submitting this form, I agree to the following terms: I release LIMELITE and Tracy Feldman and associates from any liabilities due to injuries that occur on premises. I am responsible for my child(ren) before, during, and after class time. (Sign)
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Type your first and last name please.