Hip Hop Don't Stop!

Choose course:

Full Name:

Date of birth

Age at time of workshop:

Address

Landline Number:

Mobile number:

Email address:

So that we can ensure you are in the correct group during the event please state your dance ability/experience and tick one of the following choices:

	I have little or no street dance experience
	I have attended street dance classes and feel confident about picking up choreography
	I have 3 or more years dance experience and have an understanding of street dance styles
	I have been studying street dance for more than 3 years and have attended classes on a regular basis

My street dance experience is as follows:

Do you have any medical conditions or allergies that we need to be aware of?:

Yes No

If you answered yes, please give details below:

Emergency contact name/number:

I agree the terms and condition

Liverpool participants - Once we have received your full payment for one place on the course, you will receive details of your free guest place