Please choose the number of students who will be attending a class:
Please Select
1
2
3
4
Up to 4 students can be included on a single form submission. Please submit a second form for additional students.
Back
Next
Student 1 Information
Student 1 Name
*
First Name
Last Name
Student 2 Information
Student 2 Name
*
First Name
Last Name
Student 3 Information
Student 3 Name
*
First Name
Last Name
Student 4 Information
Student 4 Name
*
First Name
Last Name
Back
Next
Parent/Guardian Information
Primary Contact Name
*
First Name
Last Name
Primary Contact Phone Number
*
Please enter a valid phone number.
Primary Contact Email Address
*
example@example.com
Back
Next
Agreement and Invoice Info
Please review and complete all sections below, then click the "Submit" button
All sections are required
*
1. LIABILITY - I, the undersigned parent and/or legal guardian of the student(s) attending, do hereby give permission for the aforementioned person (or persons) to participate in any and all class-related classes, programs, shows, and events offered by the Center. I accept all risks associated with that participation and understand that there is a full possibility of serious physical injury. I understand and accept that the Center, its staff, instructors, or their landlords are not responsible for injury to myself or my child(ren), whether based on allegations or not, in any way, by any reason of my participation in the Center’s classes, rehearsals, performances, and/or any other related events. I also affirm that I now have and will continue to carry proper medical, health, hospitalization, and accident insurance, which I consider adequate for my dancer. I understand and accept that the Center is not responsible for the immediate medical needs of its students. In consideration thereof, I agree to keep updated emergency contact information on file where a contact person may be reached during class, classes, rehearsals, performances, and related programs/events. I understand and accept that dance instruction may include or require an instructor to physically touch a dance student during class time for purposes of alignment or correction of proper dance technique. I understand and accept that the Center will not be held responsible for any loss or damage to any personal property brought onto the premises or at performance/rehearsal sites.
2. MEDIA RELEASE - I understand that photos and videos will be taken during the course of the dance season. I understand and agree that my child's image/likeness may be used in advertising, press releases, or social or print media without expectation of recompense.
I have read and agree to the terms above
*
First Name
Last Name
Submit
Should be Empty: