Fireworks Dance Center 7-Day FREE Dance Classes Pass Sign-Up Form
Please complete one form per student
We'll contact you within one business day to complete the registration.

To review the classes you're registering for, please check out our schedule at www.fireworksdance.com/classes.
Your Dancer's Information
Dancer's Full Name *
Your answer
Student's Birthdate *
MM
/
DD
/
YYYY
Please note any disabilities, allergies or health problems we should be aware of
Your answer
Pick All the (age- and level-appropriate) Classes You Want to Try in Your 7 Days FREE!
Check out our class schedule at www.fireworksdance.com/classes.
If you aren't sure of the correct level or style, we'll help you sort that out when we confirm your free 7-day class pass. Or you may call us at 484-494-8700 or email love2dance@fireworksdance.com.
Dance Classes You're Interested in Trying Out During Your Free Week! Please include dance style, day and time. List them ALL! No limit to the number of classes in the 7-days! *
Your answer
Your (Parent/Guardian) Information
Parent/Guardian's Name *
Your answer
Parent/Guardian's Mobile Phone Number *
Your answer
Parent/Guardian's Email Address *
Your answer
Mailing Street Adress *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
We'd Like To Know
Whom can we thank for referring you to Fireworks Dance Center?
(We love referrals! For NEW FDC students only. The referring FDC dance family receives a referral reward for each new FDC dance family that registers and stays as a paying family for at least one full month.)
Your answer
How did you hear about our studio? *
Please explain more: Who is the family/friend? Or at what event? Or what newspaper? Where did you see our flyer/ad?
Your answer
Important Stuff
RELEASE OF LIABILITY: Activities at Fireworks Dance Center, Inc. are physical and with all physical activities, injuries are possible. I understand and will not hold Fireworks Dance Center, Inc. or its teachers responsible for any injury or loss that may occur. When sending your child to Fireworks Dance Center, Inc. I understand my child should be covered by my own insurance and I will not hold Fireworks Dance Center, Inc. responsible for accidents that may occur. It is agreed that participating in any class taught or organized activity at Fireworks Dance Center is undertaken at the sole risk of the student. Students, parents, and guardians hereby agree to hold harmless, release, and forever discharge Fireworks Dance Center, its employees, contractors, consultants, advisors, and owners from any and all claims for injury or damage to the student’s, parent’s, guardians’ and visitors’ person or property arising out of or in connection with participation in any event or class taught by Fireworks Dance Center and from all acts of active or passive negligence on the part of Fireworks Dance Center and any of its employees, contractors, consultants, advisors, and owners. *
Required
PHOTO RELEASE: Fireworks Dance Center is given all rights to use photos/videos for promotional use. I give Fireworks Dance Center Inc. permission to photograph my child and to use the photographs around the facility and as a promotional tool. *
Required
Please confirm consent of above releases by entering your first and last name below *
Your answer
We're Here To Help
Fireworks Dance Center loves to welcome new students and families.
We are at the studios Mondays through Friday evenings, Wednesday and Saturday mornings. Let us know if you have any questions or concerns.
Any questions or comments?
Your answer
Thank you for registering for your 7-Day Free Dance Class Pass!
We'll be in touch within one business day. Feel free to call us (484-494-8700) or email us (love2dance@fireworksdance.com) with any questions.
By submitting this form, you are consenting to receive marketing emails from: Fireworks Dance Center, 11 W Winona Ave., Norwood, PA 19074, United States, www.fireworksdance.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Mailchimp.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy