EO MVMNT Class Registration FormBefore filling out the registration form please check the appropriate box below: *My child is a first time studentMy child has taken a movement class with Tine beforeChild's Name (First and Last) *Parent/Guardian Name(s) (First and Last) *Birthdate and Age? Parent/Guardian Email *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryPhone Any additional siblings that will be taking class? Please include their first and last name(s), age(s), birthdate(s), and gender(s). 10% Discount for Siblings!How will you be paying for class registration? Please bring your method of payment on the first day of class. Contact Tine for late registration. The fee will be prorated. Rhythm + MVMNT Reg. $234 - *Friend/sibling 10% Discount $210 CashCheck payable to: Christine FerrerPAYPAL (Friends & Family) to: c.joy.ferrer@gmail.comIf you refer a friend (or have a sibling) and they register for the class, you get a 10% discount off your registration fee. If you are joining class with a friend or sibling, what is their name?Please read carefully, before checking the box below: I, parent guardian, authorize a media release with the understanding that any photos, articles, student work, video footage, etc. from my son/daughter may be used for promotional materials. I understand that Eyes Opened (EO) staff and volunteers will take the utmost care of my child, and in the unforeseen event of lost or damaged property, or unavoidable injury to my child, I will not hold EO (Christine Joy Ferrer AKA Tine) or its staff/volunteers liable. I understand the goals of EO and gladly support my child, and the EO facilitators, in achieving these goals.I consentI decline VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
