Mindful Movement I Class Registration

PARENT/GUARDIAN INFORMATION
Primary Parent/Guardian or Adult Student*

First NameLast Name
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Email*
example@example.com
Second Parent/Guardian (if applicable)

First NameLast Name
Second Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.

2026 SHORT SESSION LIABILITY WAIVER
By signing below, I hereby release Hosanna Dance, LLC, & their agents/representatives of liability for any injury to my child/ren (or myself) in class, on the campus, or while participating in Hosanna sponsored performances. In the event of an medical situation, I authorize a representative of Hosanna Dance to initiate necessary medical treatment. I understand that an attempt to contact parents/guardians/emergency contacts, will be made as soon as possible. I understand that my medical insurance carrier and I are financially responsible for any medical treatment extended to my child/ren (or myself) and that Hosanna Dance and its agents or representatives cannot be held accountable or liable for such medical treatment.

I furthermore give Hosanna Dance authority to use the partcipant's image in photographs, videos, and web pages for promotional purposes.
Signature (parent/guardian signature required for participant under age 18)*

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Emergency Contact Name*

First NameLast Name
Emergency Contact Name*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Dancer*

PAYMENT
Full payment is due by the end of the first class of the session. Payment by Credit Card, Cash, or Check can be made in the Studio Office or by phone during our regular business hours.

If you would like to pay ahead of time, please indicate below and the office will contact you for payment information.
I would like to pay now. Please contact me for payment information.
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Mindful Movement I 2026