Dance Program Registration & Liability Waiver Form 🎶✨

Dance Program Registration & Liability Waiver Form 🎶✨

Please complete this form to register your child for Arianna's Dance Movement Co. and acknowledge safety policies.
Parent/Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Student Information
Student Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Allergies, Medical Conditions, Injuries, or Special Accommodations
Class Registration
Select Class

Other
If Other, specify class name
Photo & Video Release
Photo consent for Company social media content
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship to Child
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Liability Waiver
I acknowledge that dance and movement activities involve physical activity and that I assume all risks associated with participation
I release Arianna's Dance Movement Co., its instructors, staff, volunteers, and facility owners from liability for injuries occurring during participation, except where prohibited by law
Electronic Signature
Parent/Guardian Electronic Signature
Date Signed

MonthDayYear
Date
Authorized Pickup Contact
Authorized Pickup Contact Name

First NameMiddle NameLast Name
Relationship to Student
Authorized Pickup Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Dance Program Registration & Liability Waiver Form 🎶✨

Parent/Guardian Information

Student Information

Class Registration

Photo & Video Release

Emergency Contact Information

Liability Waiver

Electronic Signature

Authorized Pickup Contact