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Destination Dance Registration
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Dancer's Name
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Untitled Title
Dancer's Date of Birth
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Street Address
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City, State, Zip Code
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Phone Number
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Email Address
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Dance Experience
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If under 18, please fill out Parent Information including full name, place of work, and contact information. Please include information for all legal guardian(s).
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In case of emergency, please contact...
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Does the dancer have any previous medical conditions or injuries?
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Does your child have any allergies?
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What are the class/classes you are interested in?
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How did you hear about us?
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Liability Consent:
Destination Dance LLC is not responsible for any injuries or stolen property.
The participant assumes the risks associated with the program and take full responsibility for the ramifications of his or her actions and physical condition while participating in this program.
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Photo Consent:
Destination Dance LLC is hereby granted permission to take photographs of the students to use in brochures, websites, posters, advertisements, and other promotional materials the studio creates. Permission is also hereby granted for the studio to copyright such photographs in its name.
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E-Signature
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