Impulse Registration Form

2026 Impulse Registration

Impulse Registration Form
APPLICANT INFORMATION
Student Headshot

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Full Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Area CodePhone Number
DATE OF BIRTH:

MonthDayYear
Gender:
PARENT/GUARDIAN

Required for dancers who are 18 & under. This parent/guardian will also be financially responsible for the above dancer.
Full Name:

First NameLast Name
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
School attending:
Previous experience?
Comments or Questions
Parent/Guardian Liability Waiver

I, the undersigned parent or legal guardian, give permission for my child to participate in classes, workshops, rehearsals, or events hosted by Impulse Arts Company. I understand that participation involves physical activity and carries inherent risks.

I voluntarily assume all risks on behalf of my child and hereby release, waive, and hold harmless Impulse Arts Company, its owners, instructors, staff, partners, and affiliates from any and all liability, claims, or demands arising from injury, illness, loss, or damages that may occur during my child’s participation.

I affirm that my child is physically able to participate and will follow all studio rules and instructor instructions.

By signing below, I acknowledge that I have read, understand, and agree to this waiver on behalf of my child.
Signature
Full Name of Whomever signs this form:

Registration Fee & First Month Tuition$120.00

Quantity

Total $0.00

Credit Card

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Cash App Pay

2026 Impulse Registration