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West Concord Dance Academy                                   Pop Up Summer Classes!
ONLINE SIGN UP (ages 5-7)
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Student Name (First & Last) *
Student Birthday *
mm/dd/year
Parent Name *
Parent Cell Phone Number *
Parent Email *
I am excited to participate in: *
(check all that apply)
Required
Pop Up Summer Classes are FREE!!   *
Why are you excited to participate?  (check all that apply)
Required
In agreeing to these terms, I agree that any accident, injury, or loss of property is not the responsibility of the West Concord Dance Academy or WCDA’s staff.  Any student may decline to participate in any activity.  If any doubt, please consult your physician before participating. I hereby grant consent and authorize the use of photographs, slides, videotapes and film of my child participating in WCDA activities for commercial and art purposes in any medium of advertising, communication, publication or publicity that will promote WCDA programs, and/or recognition of participants. *
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Electronic Signature (parent) *
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