2025-2026 Registration Form

2025-2026 Competition Team Registration Form
Dancer's Name:*

First NameLast Name
Dancer's Age*
Dance DOB

MonthDayYear
Date
Dancer's T-shirt and Pants size*
Desired Extra Routines (All dancers will participate in two small groups):

SoloDuetTrio
Does your dancer have allergies?*

YesNo
If yes, please specify.
Emergency Contact Information

Please enter the name of parent or guardian who should be contacted in case of an emergency.
Relationship:*

ParentSiblingFriendOther
Full Name*

First NameLast Name
E-mail Address*
example@example.com
Contact Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I, First Name Last Name , under the terms of this Agreement and sufficiency of which is hereby acknowledged, do hereby release and forever discharge Misty's Dance Gallery, including their agents, employees, successors and assigns, and their respective heirs, personal representatives, affiliates, successors and assigns, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not herein named, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, which I and my child, First Name* Last Name* , now have or may hereafter have, arising out of or in any way relating to any and all injuries and damages of any and every kind, to both person and property, and also any and all injuries and damages that may develop in the future, as a result of or in my use or my child's use of facilities and participation in activities.

I, First Name Last Name , agree to allow Misty's Dance Gallery to use my child's image and first name only in any or all social media posts, advertisements, and promotions
Signature*

Clear
Date*

MonthDayYear
Date