Spring 2017 Youth Batizado

Registration Page

Child's Name *

Child's Name

First Name

Last Name

Child's Capoeira Nickname *

If child has no nickname yet, type "None."

Child's Date of Birth *

Child's Date of Birth

MM

DD

YYYY

Child's Gender *

Male

Female

Child's Training Location *

Child's Cord *

Child's Age Group *

Child's T-Shirt Size *

Parent's Info

Parent's Email Address *

Parent's Address *

Parent's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Special Notes

Payment Type *