Clone of Free Trial Class for New Dance Student

Line Dance Class Registration

$10 per participant, each participant needs to fill out a form and submit payment, fee is non refundable, light refreshments will be served.
Customer Details:
Participant Name

First NameLast Name
Parent/ Guardian Name, if participant is under 18

First NameLast Name
Participant Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Format: (000) 000-0000.
E-mail
example@example.com

Admission

$10.00 Quantity

Total

I understand that Artistic Dance Xpressions, LLC is not responsible for personal property lost or stolen while participating in any activities or on the Artistic Dance Xpressions, LLC premises. I also give my permission for Artistic Dance Xpressions to use photographs, film footage or any recordings without limit or obligation, that may contain myself and/or my child/children's image and or voice, for purposes of promoting Artistic Dance Xpressions, LLC and its service offerings.

I understand that Artistic Dance Xpressions, LLC assumes no responsibility for injuries or illness which myself and/or my child/children may sustain as a result of my and/or his/her physical condition or resulting from my and/or his/her participation in any activities on the premises, related to or taught by Artistic Dance Xpressions, LLC. Unless it is proven that Artistic Dance Xpressions, LLC was grossly negligent, I hereby release and discharge Artistic Dance Xpressions, LLC, its agents and employees from any and all claims for injury, illness, loss of life, damages and losses which myself and/or my child/children suffers as a result of my and/or his/her participation in these activities.
By signing below you agree to pay the $10 non refundable admission fee and the liability waiver.
Which Line Dance are you interested in Learning?

Other
Should be Empty:

Line Dance Class Registration