Amp Dance Family Registration 2019-2020
Fall classes: August 12 – December 14
Spring classes: January 13 – June 5
Recital: Saturday, June 6 (possible additional show on Sunday, June 7)

Labor Day: no class on Monday, Sept. 2
Thanksgiving break: Class only on Monday, Nov. 25; off Nov. 26-30
Spring break: closed March 23 - April 3 (make-up classes may be scheduled during this time)

Email address *
Dancer last name *
Your answer
Dancer first name *
Your answer
Dancer age (on the first day of class- August 12) *
Your answer
Grade in school (on first day of class) *
Your answer
Parent name (if student under age 18 years old)
Your answer
Phone number *
Your answer
Mailing address *
Your answer
Medical Conditions and Medications *
Please list any medical conditions and corresponding medications. If no medical conditions or medications, please write N/A.
Your answer
Emergency Contact *
Please provide the name and cell phone number of the preferred emergency contact for the student.
Your answer
Waiver and Release: I do hereby waive, release, and discharge Amp Dance Family, LLC and respective staff and employees from any and all rights and claims for damages resulting from injuries to my person or property which may be sustained or suffered by me in connection with, my association with, or participation in, or arising out of my traveling to or from the Amp Dance Family Workshops. I understand that my picture or my likeness may be used on the Amp Dance Family website or social media channels only. *
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