Adult Ballet Lessons
Full Name
*
First Name
Last Name
Preferred Skill Level
*
beginner
Intermediate
Preferred Pronouns
*
for example: she, her, hers, he, him, his, or they, them, theirs
Phone Number
*
E-mail
*
You will receive class info here
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact person
*
First Name
Last Name
Emergency contact phone
*
Emergency contact phone
What would you like to gain from class
How did you hear about us?
*
Waiver of Liability & Photo Release
Waiver of Liability & Photo Release By signing below I agree and understand that I acknowledge that this is a physical active and inherently involves a small risk of injury. I understand that this activity will involve Theatre Arts related activities. I hereby agree to hold T3 Triple Threat Youth Mentors (T3), or any of its affiliates harmless for any injury to myself/my child resulting from me/my child’s participation. I will not sue T3 or any of its affiliates for any injury, loss or property or damage resulting from participation in this activity. Additionally I give my permission and understand T3 may use any photos and video footage taken for promotional purposes. These materials may be used at any time.
Name
*
First Name
Last Name
Date
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Month
-
Day
Year
Date
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