Form

Full Name

First NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Liability Agreement

I acknowledge that participation in dance classes, workshops, rehearsals, and activities at Catch These Counts Studio involves physical activity and risk of injury.

I voluntarily assume all risks and release Catch These Counts Studio, its owner, instructors, and staff from any claims, injuries, or damages that may arise from participation.

I confirm that I am physically able to participate and understand I should consult a physician if I have any concerns.

I understand photos or videos may be taken for promotional purposes unless I notify staff in writing.

Electronic Signature (Type Full Legal Name)

By typing my full name above, I agree this serves as my electronic signature.