Trial Lessons GLOW WEEK

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 Birthday *

Date

Age 2

Age 3 & 4

Ages 5-7

Ages 8-11

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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