Trial Lessons November

Parent/Guardian Name *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Dancer Name *

First Name Last Name

What Age/Grade Category Does Your Dancer Fall Into? *

Dancer's Birthdate *

Date

Age 2 By Oct 1

Age 3 By Oct 1

Age 4 By Oct 1

Mini Program (Kindergarten & 1st Grade)

Petite Program (2nd & 3rd Grade)

Tween Program (4th & 5th Grade)

What Age/Grade Category Does Your Dancer Fall Into?

Parents, legal guardians of minors and adults waive the right to any legal action for any injury sustained on Dance It Up with Music Property or event resulting from normal class/physical activity or any other activity conducted by the participant before, during or after class time. I have my own medical insurance to cover any and all medical bills or related bills that may arise from the nature of the activity. I release Dance It Up with Music from all financial responsibility from any expense that is incurred for any unfortunate situation that may occur. I also consent to my child's photo being used in any images or marketing by Dance It Up with Music. *

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