Dil Se Dance Co. Registration Form

Registration Form
Dil Se Dance Company
Please fill out the form and click submit when finished.
Personal Information
Parent Name

First NameLast Name
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Email Address
Phone Number
Please enter a valid phone number.
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any vital information we may need to know such as of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Do you allow your child's photograph and video to be taken and used on social media platforms? Answer with Yes or No below. *
Notes

Dil Se Dance, LLC Waiver

I, First Name* Last Name* understand that physical activity in dance class involves a certain amount of risk and I release Dil Se Dance, LLC and its instructors and staff from all liability against any and all claims, actions, cause of action, damages, costs, liabilities, expenses, or judgements, including attorney fees, and court costs, arising from the my or my child’s participation in the program. I hereby execute this waiver and release form to Dil Se Dance, LLC and permit myself (or child) to participate in their program.

*
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