THE RAGE DC TRIAL BOOKING FORM

THE RAGE DC TRIAL BOOKING FORM
Student Name

First Name Last Name
Parent Name

First Name Last Name
Parent Contact Number
Please enter a valid phone number.
Parent Email
example@example.com
Child Allergies that are relevant to their participation in class:
Select Classes

INTERMEDIATE ELITE CONDITIONING (MONDAY 5-6PM) INTERMEDIATE ELITE BALLET (MONDAY 6-7:30PM) MINI BALLET (TUESDAY 4:30-5PM) MINI TAP (TUESDAY 5-5:30PM) MINI JAZZ (TUESDAY 5:30-6PM) JUNIOR RECREATIONAL ACRO (TUESDAY 5-5:45PM) JUNIOR RECREATIONAL HIP HOP (TUESDAY 6-6:45PM) JUNIOR RECREATIONAL TAP L (TUESDAY 6:45-7:30PM) INTERMEDIATE 14-18 HIP HOP (WEDNESDAY 6:15-7:15PM) INTERMEDIATE 14-18 TAP (WEDNESDAY 7:15-8:15PM) MINI ACROBATICS (THURSDAY 4:30-5PM) MINI HIP HOP (THURSDAY 5-5:30PM) JUNIOR RECREATIONAL BALLET (THURSDAY 5-5:45PM) JUNIOR RECREATIONAL JAZZ (THURSDAY 5:45-6:30PM) JUNIOR RECREATIONAL LYRICAL (THURSDAY 6:30-7:15PM) PRESCHOOL DANCE (SATURDAY 8:30-9:15AM) PRESCHOOL DANCE (SATURDAY 9:30-10:15AM) INTERMEDIATE/ ADVANCED OPEN ACRO (SATURDAY 10:30-11:30AM) INTERMEDIATE PILATES (SATURDAY 11:30-12:30PM) INTERMEDIATE ELITE BALLET (SATURDAY 1-2:30PM) INTERMEDIATE ELITE LYRICAL/ CONTEMPORARY (SATURDAY 2:30-3:30PM) INTERMEDIATE ELITE JAZZ (SATURDAY 3:30-4:30PM) 14-18 YEARS BALLET (SATURDAY 1:15-2:15PM) 14-18 YEARS RECREATIONAL LYRICAL/ CONTEMPORARY (SATURDAY 2:30-3:30PM) 14-18 YEARS RECREATIONAL JAZZ (SATURDAY 3:30-4:30PM) I AM INTERESTED IN THE JUNIOR ELITE PROGRAM
Week of Commencement (select date)

Month Day Year
Date
I give permission for photography and videography of my child to be used for promotional purposes only:

Yes No
I, blanks, agree in no way to hold The Rage Dance Company responsible for any incident or injury that may occur whilst partaking in class. By signing below, I release The Rage Dance Company from all liability.
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