Please fill out this form and submit for dance services.
* Required Field
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Student's name:
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Email:
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Address:
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Date of Birth:
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Age:
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Parents Name:
What kind of dance are
you interested in?
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Telephone:
Salsa
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Cell Phone(s):
Hip Hop
Street
Jazz
Private Salsa/Mambo Lessons
"One on One On 2"
for individuals or couples
Contemporary
Dance
Private Group Lessons
(For Groups of 5 or more).  This
includes Praise & Worship training for
churches and other youth ministries.
 Other:
CHOREOGRAPHY for Weddings,
Sweet 16s, Quinceneras, Proms,
talent shows, or any special event
If you have a special request, please enter below.  
Questions, comments, or feedback are encouraged:
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All Rights Reserved Immanuel Dance Center, Inc., Immanuel Ministries, Immanuel Dance Company
Webmaster@immanueldancecenter.com
All pictures, videos and other media is the property of Madi Portes and Immanuel Dance Center, Immanuel Ministries and Immanuel Dance Company