Free 2 Week Class Pass
1514 Isett Ave. Muscatine, IA 52761
563-500-2762
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Email *
Parent/Guardian Name *
Phone Number *
Address *
Student Name & Age *
Baby/Toddler - Caregiver & Me (ages 1-3)
Discover Dance Program (ages 3-5)
Please select the class(es) you are wanting try:
Kidance Program (Ages 5-8) 
Please select the class(es) you are wanting to try:
Academy Program (Ages 7-8)
Please select the class(es) you are wanting to try:
Academy Program (Ages 9-13 & Ages 14+) 
Please select the class(es) you are wanting to try:
What Date would you like to start the Free 2 Week Trial?
MM
/
DD
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YYYY
Pre-Blossom Program (ages 14+) 
These classes are on Wednesday and with the competition students. Students need to be evaluated for this program or they can join the Academy Program on other nights. 
Please select 'yes' if you would like to be contacted about the Pre-Blossom program. 
Emergency Contact - Name & Phone Number *
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Do you have any questions or is there anything we need to know about your child? Please write it below.
Questions?
Contact us at office@mamusicanddance.com or text/call 563-500-2762. 
Thank you! 
Thank you for your interest! 
You will receive an email within 24hrs with more information regarding your child's trials.
We look forward to meeting you! 
A copy of your responses will be emailed to the address you provided.
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