Art in Motion Pittsburgh Student Contact Form
Please fill out this form even if you are already enrolled. We are creating a new database for emergency situations, last minute cancellations due to weather, and to keep our insurance forms up to date! We will not release this information to anyone! Thank you in advance!
Name of Dancer(s)- if more than one student please enter all names separated by a comma *
Your answer
Parent/ Guardian Name (if applicable)
Your answer
Email *
Your answer
Address
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Phone number *
Your answer
Dancer's Date of Birth *
Your answer
Studio Policy: I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Art in Motion Pittsburgh, LLC classes, rehearsals, performances, or activities. I also exempt, release, and indemnify Art in Motion Pittsburgh, LLC, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Art in Motion Pittsburgh, LLC. All tuition is NON –REFUNDABLE, NON-TRANSFERABLE and due by the 10th of every month. PLEASE see Ms. Jen or Ms. Lucy about payment options. Please initial below. *
Your answer
I allow Art in Motion Pittsburgh to photograph my child/myself in classes and showcases and to use for promotional purposes. Please initial if you agree. *
Your answer
Please list any allergies or medical conditions we should know about your child EXAMPLE: Asthma, Peanut allergy etc.
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Which class are you interested/ currently enrolled in?
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How did you hear about us? Friend, website, google search, facebook ad, instagram, etc?
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