ACDA TRIAL PERIOD 2026

✨FREE TRIAL PERIOD✨JANUARY 5-15, 2026✨

The ACDA offers a FREE TRIAL PERIOD for all Academy dance classes! This form must be completed for you and/or your child to participate. Dancers may attend as many free classes as they would like during this period! VIEW OUR FULL CLASS SCHEDULE HERE-> www.artscastle.org/dance 🤗
Dancer’s Name*

First NameLast Name
YESNO
Age*
Street Address*
City, State Zip*
Parent/Guardian Information OR Your Name and Information*

First NameLast Name
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Work Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
By PhoneBy TextBy Email
Emergency/Medical Information

If you are not reachable, please list another adult to whom the student may be released/who may be contacted in case of emergency:
Emergency Contact’s Name*

First NameLast Name
Relationship*
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alt. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Others authorized to pick up student, please list name and relationship:
So that we may better assist you/your child and also in case of emergency, please list allergies, dietary restrictions, medical conditions, medications being taken, physical impairments and/or special needs:
EPI-PENS, INSULIN KITS & INHALERS

If students typically keep these medications with them at school, then students should keep these medications with them while in class.

In the event that a medical history needs to be obtained, the following are my/my child's usual caregivers:
Please list any other information you think we should know regarding your child:
Emergency Medical Authorization:

In the event reasonable attempts to contact me or another authorized person listed above have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary and/or the transfer of myself/my child to any hospital reasonably accessible.
Emergency Medical Authorization*
Please list the ACDA class(es) that you or your child will be participating in for Trial Week:*
Participant Waiver

BY SUBMITTING THIS FORM you grant permission for the The Arts Castle to use photographs and/or videos of you or your child in publications, marketing materials, website, social media and in other communications related to the mission of The Arts Castle.

BY SUBMITTING THIS FORM, you release and discharge the Delaware County Cultural Arts Center (The Arts Castle), their agents and employees for any damages, actions, demands and injuries arising out of any participation in this activity, whether they arise at The Arts Castle, out of travel between The Arts Castle and any off-site location, or at any offsite location while participating in the program and have full knowledge of all risks involved in my/my child's participation in the class.
Should be Empty:

✨FREE TRIAL PERIOD✨JANUARY 5-15, 2026✨