Sparkle Spotlight Dance Registration Form

Sparkle Spotlight Dance Registration
Personal Information of Dancer
Date of Birth *

Month Day Year
Date
Name *

First Name Last Name
Where does this student attend school? *
Gender *

Male Female
Student Grade (2021-2022 School Year) *

Parental Information and Submission
Name of Parent *

First Name Last Name
Phone Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
AUTHORIZED PICK-UP! Please list the First and Last Names of persons you give permission to pick up camper up.
Anyone picking-up a child must show valid ID and be listed as an approved individual at the time of pick-up
Please list any emergency contacts, their relationship to camper, best phone numbers or other contact information that will be helpful in an emergency. *
I, hereby grant ART Inc Staff permission to authorize medical, dental, and/or hospital attention to your child. You understand that matters of any severity will be discussed as reasonably as possible after the initial incident. ART Inc and its staff cannot be held responsible for any repercussions caused as the result of treatment. I also grant permission for images of my child to be used for either Promotional Materials and/or Digital Showcase. By granting permission, I am agreeing to:
- Promotional Materials – I hereby grant permission for images of my child, captured through video, photo, and digital camera, to be used solely for the purposes of educational and promotional material, publication in print, ART Inc's website, ART Inc's social media sites. I hereby wave my rights to inspect and approve the finished product or copy that may be used in connection with an image and of compensation or ownership thereto.
Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.) * *

First Name Last Name
Relationship to registered dancer: *
Current date *

Month Day Year
Date

Choose Your Class!
Registration Fees will be paid through PayPal and must be completed in order to complete the registration process online. YOU DO NOT need to have a PayPal account to use this system and may use a credit card or debit card. If you do not have a Paypal account you may sign in as a "guest".

Only one dancer may be registered at a time.
My Products
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Mini Sparkles monthly class for ages 4-6
$ 80.00

Jr. Sparkles Monthly class for ages 7-9
$ 80.00

Sparkles Monthly class for ages 10-12
$ 80.00

Total

$ 0.00
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Sparkle Spotlight Dance Registration

Personal Information of Dancer

Parental Information and Submission

Choose Your Class!