Student Contact InformationFirst Name Last Name Phone Number Whatsapp Number Email AddressAddress Line 1 City Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBirth Date Are you 18 years of age or older? - Select -YesNoIf you are under the age of 18, please provide the Full Name and Phone Number of a Guardian who will be contacted to confirm Registration.Guardian First Name Guardian Last Name Guardian Phone Number All students must provide an Emergency Contact. Please provide Full Name and Phone Number. This contact must live in the surrounding area. Emergency Contact First Name Emergency Contact Last Name Emergency Contact Phone Number Do you have any allergies, injuries, or medical conditions? - Select -YesNoPlease list all allergies, injuries, or medical conditions Class InformationPlease choose which package you are interested in Starter: $50/month for 1 class per week Basic: $80/month for 2 classes per week Committed: $100/month for 3 classes per week Drop In: $20/class Private Classes: Price to be discussedAcknowledgment Please view the following sections on the Website before completing this section: Classes PoliciesI have read and understood the different class packages and offerings from La Piel de Naranja, located on our Website Yes No I have more questions, if someone can please contact meI have Read, Understood, and Agree to the following Policies listed on the Policy section of the La Piel de Naranja Website Waiver Agreement Promotional Material Policy Cancellation Policy Payment Policy In Case of Emergency COVID Policies Privacy Policy Holiday ClosuresPlease choose which classes you would like to attend (Check All That Apply) Monday 2:00-3:00PM: Mixed Arts (Toddlers) Monday 3:30-4:30PM: Aerial Silk Kids (Ages 5-10) with Melissa Monday 4:30-5:30PM: Aerial Silk Kids (Ages 10- 15) with Melissa Monday 5:30-7:00PM: Film Creation (Ages 15+) with Esteban Tuesday 8:00-9:00AM: Pole Dance (Ages 15+) with Leo Tuesday 9:30-11:00AM: Óleo Painting with Hazel Tuesday 3:30-4:30PM: Gymnastics for Kids with Leo Tuesday 4:30-5:30PM: Ballet Jazz for Kids with Leo Tuesday 6:00-7:00PM: Contemporary Dance (Ages 15+) with Melissa Wednesday 8:30-9:30AM: Aerial Silks (Ages 15+) with Melissa Wednesday 3:30-4:30PM: Bungee Dance for Kids with Esteban & Melissa Wednesday 4:30-5:30PM: Aerial Arts for Kids with Leo Wednesday 5:30-6:30PM: Aerial Arts (Ages 15+) with Leo Thursday 8:30-9:30AM: Swing Yoga with Melissa Thursday 3:30-4:30PM: Piano for Kids (Ages 7+) with Melvin Thursday 4:30-5:30PM: Visual Arts for Kids with Hazel Thursday 6:00-7:00PM: Belly Dancing with Tefa Friday 8:30-9:30AM: Photography And Digital Editing (Ages 15+) with Esteban Friday 3:30-4:30PM: Dance Theatre for Kids with Melissa & Esteban Friday 4:30-5:30PM: Percussion for Kids (Ages 3+) with Melvin Friday 5:30-7:00PM: Aerial Silks (Ages 15+) with MelissaI agree to be notified by Whatsapp, Text, and/or Email about upcoming events, classes, schedule changes, and other notifications Yes NoIs there anything else you would like for us to know? Please write your personal message here and we will answer your question when we confirm your registration. Submit Form
