Summer 2023 Free Trial Class

Dancer's Name Dancer's Name First Last
Dancer's Age
Classes for Dancers Age 2

Classes for Dancers Age 2 Tiny Dancers
Classes for Dancers Age 3

Classes for Dancers Age 3 Tumbling Tots Tiny Dancers Hip Hop Tots Princess Ballet
Classes for Dancers Age 4

Classes for Dancers Age 4 Tumbling Tots ACRO TUMBLE DANCE I/II Tap N' Ballet Tiny Dancers Hip Hop Tots Princess Ballet
Classes for Dancers Age 5

Classes for Dancers Age 5 ACRO TUMBLE DANCE I/II Tap N' Ballet Tiny Dancers Jazz I/II Tap I Hip Hop Tots Kids Bop
Classes for Dancers Age 6

Classes for Dancers Age 6 ACRO TUMBLE DANCE I/II Tap N' Ballet Jazz I/II Ballet Workshop Tap I Kids Bop
Classes for Dancers Age 7

Classes for Dancers Age 7 ACRO TUMBLE DANCE I/II ACRO TUMBLE DANCE II Jazz I/II Ballet Workshop Tap I Kids Bop Hip Hop
Classes for Dancers Age 8

Classes for Dancers Age 8 Ballet Wkshop ACRO TUMBLE DANCE II SR/ Teen Sr ADV ACRO TUMBLE DANCE II/III Jazz I/II Ballet Workshop Tap I Tap II Hip Hop Lyrical I/II
Classes for Dancers Age 9

Classes for Dancers Age 9 Ballet Wkshop ACRO TUMBLE DANCE II SR/ Teen Sr ADV Hip Hop II/III Ballet II/III Jazz III Tap II Lyrical I/II Modern I/II Lyrical I/II
Classes for Dancers Age 10

Classes for Dancers Age 10 Ballet Wkshop SR/ Teen Sr ADV Hip Hop II/III Ballet II/III Jazz III Tap II Modern I/II Lyrical I/II
Classes for Dancers Age 11

Classes for Dancers Age 11 Ballet Wkshop SR/ Teen Sr ADV Hip Hop II/III Teen Jazz Ballet II/III Hip Hop Jazz III Tap II Teen Modern INT Tap Modern I/II Lyrical I/II
Classes for Dancers Age 12

Classes for Dancers Age 12 Ballet Wkshop SR/ Teen Sr ADV Hip Hop II/III Teen Jazz Ballet II/III Hip Hop Teen Open Level Jazz III Tap II Teen Modern INT Tap INT Teen Tap Modern I/II Lyrical I/II INT Lyrical
Classes for Dancers Age 13+

Classes for Dancers Age 13+ Junior Teen Intermediate Contemporary Adult Jazz Hip Hop II/III INT/ADV Ballet Teen Open Level INT/ADV Jazz Teen Modern ADV Tap INT Tap ADV Modern Ballet II/III Teen Hip Hop ADV Ballet ADV Senior Lyrical INT Lyrical
Date of Birth Date of Birth / MM / DD YYYY
Parents/Guardians
Email
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Bus/Cell Phone Bus/Cell Phone - ### - ### ####
School
How You Heard About Us
Emergency Contact

Person to contact in case parent or guardian is unavailable
Name Name First Last
Relationship
Release
I understand dance is a physical activity which requires strenuous movement and involves risks of serious bodily injury. I have/will check with our doctors to make sure both my child and myself are in good health, in proper physical condition and qualified to participate in a DEDA* class, activity or event offered in a DEDA* studio, other location or on a virtual platform.

I fully understand, accept and assume all risks and all responsibility for any physical injury, emotional injury, illness, loss of personal property or damage to personal property as a result of my child’s or my participation in any DEDA* class, activity or event offered in a DEDA* studio, other location or on a virtual platform.

I agree to hold harmless, release, discharge and I covenant not to sue DEDA*, its owners, director, officers, employees, independent contractors, volunteers and any other participants for losses, costs, and damages from all liability, claims, demands, losses and damages my child and/or I incur as a result of my child's participation or my participation in any DEDA* class, activity or event offered in a DEDA* studio, other location or on a virtual platform.

I understand my child’s, or my participation may result in possible exposure to illness from infectious diseases, including, but not limited to, MRSA, Influenza, and COVID-19. I knowingly and freely assume all such risks, both known and unknown and I will not hold DEDA*, its owners, director, officers, employees, independent contractors, volunteers and any other participants liable for any illness or injury which may result from possible exposure to infectious diseases as a result of participation in any DEDA* class, activity or event offered in a DEDA* studio, other location or on a virtual platform.

I understand that DEDA* will make every effort to follow guidelines issued by the appropriate authorities relative to the wearing of masks, social distancing, and other requirements. I also acknowledge and understand that there may be times when for whatever reason a student or teacher is not wearing a mask or social distancing for some period of time offered in a DEDA* studio, other location or on a virtual platform.

I give permission to DEDA* to use photos and or video of my child, my child's siblings, my property, and myself without remuneration in connection with studio publications, social media, advertising, newspaper, and TV coverage. My child’s name, my child's siblings name or my name may or may not be used in these formats.

I, hereby covenant and promise that I am the minor’s parent and/or legal guardian .

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
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Date Date / MM / DD YYYY

Summer 2023 Free Trial Class

Summer 2023 Free Trial Class

Emergency Contact

Release

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