The Spirit of Dance Registration
Student First Name *
Your answer
Student Last Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Parent First Name *
Your answer
Parent Last Name *
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
Alternate Phone Number *
Your answer
Street Address
Your answer
City, State & Zip code
Your answer
Select Class Option Below *
Select 6 or 7 week Session (Costs at Top of Page) *
Liability Agreement: My child has permission to participate in The Spirit of Dance programs. I waive any right to claim against The Spirit of Dance staff and teachers in the event of accident, injury, or loss of personal items. Children must be insured to participate in The Spirit of Dance programs. I have read or have had read to me the foregoing in its entirety and by placing my electronic signature below do declare that I understand that any cost or injury resulting from participation in this activity is my responsibility. *
My child’s photographs or video image my be used on promotional or informational materials, press media, and possible publication on the World Wide Web through the church’s web page or The Spirit of Dance website taken for positive public relation purposes *
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