ULTIMATE DANCE ON THE MOVE- Liability waiver Please complete in order to be able to participate in events & classes at one of our locations. All students must have an updated liability waiver on file & if you are looking to schedule your child's introductory class please call and schedule it with the studio ahead of time as intro trial classes are not always available . (630)809-2010
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)
Students entered below will be added to your family's account
What event/class are you signing the liability waiver for?*
I understand that if my child has any medical needs or information that the studio should know that I will tell the staff at the event/class they attend so they are aware.*
I understand that if my child is attending a birthday party that it is a drop off party and I am welcome back 5 minutes before the end of the party to watch their dance they learned.*
Additional Information:
COVID Liability Release
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I've read the above and agree.
Liability Waiver
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I've read the above and agree.
Picture Release
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I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments: