Lady M Dance Registration Form

Name*

First NameLast Name

MaleFemale

Age*

Date of Birth*

Date

Phone number*

Insert parent/guardian contact if you are under 18.

Parent/Guardian Name*

For students under 18yrs old

Phone Number*

Contact number for parent/guardian.Format: (000) 000-0000.

E-mail*

example@example.com

Emergency Contact*

Please state: Name - Relationship - Contact Number

Social Media

We want to follow you! Insert your Instagram handle!

Kids (4yrs-12yrs)Teens (13yrs-17yrs)Adult Soca Fit (18yrs+) (start date TBA soon)

Monthly $200/mthDrop in $60/class

Intended Start Date*

Online transfer/Fast depositCash in hand

DISCLAIMER/WAIVER

Dance Class can involve the risk of personal injury. While our instructors take reasonable care in the conduct of our classes, the Lady M dance Troupe accepts no responsibility for injury caused before, during or after classes. You are responsible for ensuring that you or your child are physically and mentally fit for classes and can abide be all instructions and expectations. If there are any considerations for your health that need to be made, please submit in writing before taking part in our classes.

I hear by grant permission to the Lady M Dance Troupe the right of my image, in video or in still and of the likeness and sound of my voice at recorded on audio or video tape with or without payment or and other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product where in my likeness appears.
Additionally, I waive any right of royalties or other compensation arising or related to the use of my image or recording unless otherwise agreed to be the Lady M Dance Troupe.

I have read and agree to the term above.

Yearly Registration Form