Registration for Shine on the Main Line Dance 2023

Participant's First Name^*

Participant's Last Name^*

Participant's Gender^*

Male
Female

Participant's Age^*

Parent/Guardian Name(s)^*

Parent Email^*

Additional Email

Address

Address Line 1

Address Line 2

City

State or Region

Zip

Cell Phone^*

Alternate Phone

Total # of individuals attending dance in your group (including participant):^*

Name of Caregiver Accompanying Participant

List names of all individuals attending in your group including the particpant. Include ages of any minor children.^*

Please share any relevant information that would help make this event successful for your group (we will do our best to accomodate requests as much as possible).

Shine Registration Fee $25

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