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Discover the magic of movement with our monthly community classes, imaginative play, and storytime. Parents or caregivers are invited to participate along with their children in these monthly events, which are the perfect opportunity to play, socialize and meet other families.
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Event: |
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Start Date/Time: |
End Date/Time:
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Fee per Student:
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Room:
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* - denotes required fields |
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Release of Liability
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I grant permission to the staff of Dance Connection to take first aid or emergency measures as judged necessary for the care and protection of my child while under the supervision of the studio. In case of medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the emergency unit deems it necessary. I understand that in some medical situations the staff will need to contact the emergency resource before the child’s parent, physician, and or other person acting on the parent’s behalf. I also understand and agree that the child’s parents or legal guardians shall be responsible for any expenses incurred. I agree to hold harmless from any and all liability Dance Connection, its officers, employees and contractors both in their professional capacity and personally for all injury or illness resulting from or in any way connected with his/her participation in the classes, activities or special events at the studio. Parents/legal guardians give their permission to the studio to use photos and or video of their child without remuneration in connection with studio publications, advertising, tv and news coverage.
I've read the above and agree.
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Other Questions/Comments: |
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>Please fill out ONE of the following Payment Methods.
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Credit Card Verification: |
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Card Number: |
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Name as it appears on card: |
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Nickname:
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Card Expiration Month: |
Exp Year:
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:
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| eCheck/Bank Draft:
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Bank Name: |
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Bank Routing Number: |
(9-digit number)
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Your Account Name: |
(Your name on your bank statement)
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Your Account Type: |
Account Number:
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