I Want to Enroll My Child in a Current Groove Move Kids Program

* Required Fields
Child's First Name *
Child's Last Name *
Child's Date of Birth *
Parent's First Name *
Parent's Last Name *
Child's School or Childcare Provider *
Street Address *
City *
State *
Zip *
Email *
Phone *
How Best to Reach You?
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Best Day(s) and Time(s) to Reach You?
How Did You Learn About Groove Move Kids?
Questions or Comments?
By checking this box I've read and understand Groove Move Kids' Waiver and agree to all terms and conditions.
Waiver

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Agree