Trial Class Release Form

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Students Name: *

Gender: *

Male

Female

DOB: *

YYYY

Class Type: *

Tiny Tots | 12mo-3yr Dance Class

Preschool Dance or Tumbling | 3-5yrs

Ballet/Jazz Combo | STAR Program | KND - Older

Tumbling | KND - Older

Hip Hop | 1st Grade - Older

Guardian Name: *

Full Address: (including city and zip code) *

Phone Number: *

Email: *

Emergency Contact Name & Phone Number: NOT LIVING IN THE HOME *

How did you hear about us? *

By typing my name below I understand that there are specific risks of physical or property damages, losses, or injury that may result from me or my child's participation with Studio 56 Dance Center and I voluntarily assume the risks associated with such participation. I release Studio 56 Dance Center and all staff officials from all claims of damages or injury suffered by the registered family in connection with their association with Studio 56 Dance Center. This includes my heirs who may not act in my behalf. *

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