registration form

Free Trial Class!

We offer a free trial class for anyone unfamiliar with our studio
or the art of Breaking.

[{"lid":"1531306243545","ls":"10","loff":"","li_parent_id":"","li_type":"nm","li_title":"Student\u2019s Full Name:","li_req":"y","li_nm":"Name"},{"lid":"1531306540094","ls":"20","loff":"","li_parent_id":"","li_type":"da","li_title":"Students DOB:","li_dateformat":"DD-MM-YYYY","li_datediv":"dash","li_req":"y","li_nm":"Students DOB:","li_datemask":"99-99-9999"},{"lid":"1663297557020","ls":"30","loff":"y","li_parent_id":"","li_type":"in","li_title":"Address:","li_nm":"Address:"},{"lid":"1663297603669","ls":"40","loff":"y","li_parent_id":"","li_type":"in","li_title":"City: ","li_nm":"City: "},{"lid":"1663298418335","ls":"50","loff":"y","li_parent_id":"","li_type":"in","li_title":"State:","li_nm":"State:"},{"lid":"1663298436564","ls":"60","loff":"y","li_parent_id":"","li_type":"in","li_title":"Zip code:","li_nm":"Zip code:"},{"lid":"1663298455001","ls":"70","loff":"","li_parent_id":"","li_type":"nm","li_title":"Guardian\u2019s Name & Relationship to Dancer:","li_req":"y","li_nm":"Name_2"},{"lid":"1663298709913","ls":"80","loff":"y","li_parent_id":"","li_type":"in","li_title":"Relationship to Dancer:","li_req":"y","li_nm":"Relationship to Dancer:"},{"lid":"1663298674023","ls":"90","loff":"","li_parent_id":"","li_type":"ph","li_title":"Cell Number:","li_masktype":"a","li_maskcountry":"US","li_req":"y","li_nm":"Phone"},{"lid":"1663298737082","ls":"100","loff":"","li_parent_id":"","li_type":"em","li_title":"E-mail:","li_req":"y","li_nm":"Email"},{"lid":"1663298752808","ls":"110","loff":"y","li_parent_id":"","li_type":"ta","li_title":"List any medical conditions\/allergies:","li_rows":"3","li_nm":"List any medical conditions\/allergies:"},{"lid":"1663298804259","ls":"120","loff":"y","li_parent_id":"","li_type":"in","li_title":"Person to contact beside parent\/guardian in case of emergency:","li_nm":"Person to contact beside parent\/guardian in case of emergency:"},{"lid":"1663299025639","ls":"130","loff":"y","li_parent_id":"","li_type":"cb","li_title":"Please check if you give permission to have your child\u2019s picture to be taken and put up on our website, Facebook, programs, and other items.","li_label":"<div style=\"font-size:18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; font-weight: 400;\">I agree<\/span><\/div>","li_nm":"Please check if you give permission to have your child\u2019s picture to be taken and put up on our website, Facebook, programs, and other items."},{"lid":"1663298826665","ls":"140","loff":"y","li_parent_id":"","li_type":"tx","li_text":"<div style=\"font-size: 18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student represents that he or she is in good physical condition and able to participate in the exercises recommended by Construct Breakin.<\/span><br \/><br \/><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student fully understands and agrees that in participating in one or more classes or using the facilities provided by Construct Breakin there is possibility of accidental injury. <\/span><br \/><br \/><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student further agrees to indemnify Construct Breakin from any accidents, injuries, or losses incurred on Construct Breakin\u2019s property.<\/span><\/div>"},{"lid":"1663299193660","ls":"150","loff":"y","li_parent_id":"","li_type":"tx","li_text":"<div style=\"font-size: 18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; font-weight: 400; color: rgb(0, 0, 0);\">By signing below, you agree to pay for tuition each month, required attire, and any other fees that may be incurred<\/span><\/div>"},{"lid":"1663299307714","ls":"160","loff":"y","li_parent_id":"","li_type":"nm","li_title":"Full Name","li_req":"y","li_nm":"Name_3"},{"lid":"1663299807446","ls":"170","loff":"y","li_parent_id":"","li_type":"da","li_title":"Date:","li_dateformat":"DD-MM-YYYY","li_datediv":"dash","li_req":"y","li_nm":"Date:","li_datemask":"99-99-9999"},{"lid":"1701798028737","ls":"180","loff":"","li_parent_id":"","li_type":"ta","li_title":"Notes \/ Comments \/ Questions","li_rows":"3","li_nm":"Notes \/ Comments \/ Questions"},{"lid":"1743027327019","ls":"190","loff":"","li_parent_id":"","li_type":"cb","li_title":"Privacy Policy","li_label":"I agree to the terms of the <a href=\"https:\/\/constructnashville.com\/privacypolicy\">Privacy Policy<\/a>","li_req":"y","li_nm":"Privacy Policy"}]

+1615 516 6604
constructNashville@gmail.com

2121 Gains Street
Nashville, TN 37207