Reg form for Shan Bhatt Personalized Registration Form for Shan Bhatt Hi Shan -- please use this personalized form to register Nandini for the Disney Descendants class. After we receive the registration, we will send along the Zoom link and additional information. Student's Name* First Last Student's Age*Parent/Guardian's Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Medical/EmotionalIf you feel that our faculty could better serve the student by being made aware of any medical or emotional issues, please explain below. All such information will be kept strictly confidential.Performing Arts Fall 2020 Classes* Disney Descendants, 4 weeks How did you hear about our winter classes?Promotional Material Permission*May Elefante Music & School for the Performing Arts use photographic images and sound bites of this student for promotional material?YesNoMailing ListSign up for Elefante Music's mailing list and stay informed on future classes!No thanksTotalReview your total. By selecting the Register button you agree to charge your credit card this amount. $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name Please click REGISTER ONLY ONCE (do not double click). If you receive an error message, email email@example.com.