Student information

Student’s First Name *

Student’s Last Name *

Age of Students (Salsarinas Only Please)

Name of Parent (For Salsarinas Only)

E-Mail (Student or Parent) *

Phone Number *

Class *Pick your Class hereLadies Intermediate @ Wed 6pmLadies Absolute Beginner @ Tues 5pmLadies Absolute Beginner @ Wed 8pmLadies Burn & Learn @ Wed 7pmSaslarinas (6-7) @ Tues 7pmSalsarinas (8+) @ Tues 6pm

Name of Student who Referred You to Salsacolada

If this is your 1st time with SalsaColada, how did you hear about us?

2 + 5 = ?Please prove that you are human by solving the equation *