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Please fill out the registration form below to submit your information to us.

NOTE that this will NOT enroll you in any classes. All this will do is send us your completed registration form by email.

All information is kept private.

Dance With Mahi, LLC
1735 Ellington Rd. (Stop & Shop Plaza)
South Windsor, CT 06074
In the WuShu Center Next to Stop & Shop!

(click map for directions)

“Shake it 'til the moon becomes the sun.”
by Vada Nobles, Carl Sturken, Evan Rogers, and Alisha Brooks, "Pon de Replay," performed by Rihanna

*Students Name:
*Age:
Parents Name: (If registering for an adult class, please enter “ADULT”)*
*Street Address:
*City, State, Zip-Code:
Home Phone: (10 digits only, no spaces or dashes)*
Cell Phone: (10 digits only, no spaces or dashes)*
*Email:
Emergency Contact Information: (Please enter at least a name and phone #)*

*Required Fields

The Show: Dhamaka 2012!