impact performing arts
2020 Winter/Spring Registration Form

2020 Showcase: TBA
2020 Showcase Dress Rehearsal: TBA
Costume Fee - $70 per performing class.
Classes marked in blue on the schedule will NOT perform.
Dancer's First and Last Name *
Dancer D.O.B *
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Parent/Guardian First and Last Name *
Parent/Guardian Email *
Cell Phone Number *
School Attending & Current Grade *
How Did You Hear About Impact? *
Any Injuries or Illnesses? *
Class Selections
Please list class(es) below.

Payment is due in FULL on or before the first class. Class fees are non-refundable.
Additional $190 for Poms, Int Ballet, Adv. Modern, Adv. Jazz & Adv. Pointe/Ballet.
25% Sibling Discount on dance class fees ONLY.
NO Sibling Discount for DanceWorx Company Members
#1 Day/Time/Class/Teacher *
#2 Day/Time/Class/Teacher
#3 Day/Time/Class/Teacher
#4 Day/Time/Class/Teacher
#5 Day/Time/Class/Teacher
Wavier
Participation in any Impact Performing Arts activity on or off site, and use of recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities conducted by Impact Performing Arts, I/we, as individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and agree to indemnify and hold harmless Impact Performing Arts, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my child or family members accruing during his/her/our participation in any activity or use of any recreational facility at or conducted by Impact Performing Arts. I also agree to the use of my child’s photo/video for Impact Promotional purposes.

I also understand that there will be a $70 costume fee for any and all classes that are performing in Showcase as indicated on the Winter/Spring Schedule.

Printing name below will serve as your signature.
I agree to the wavier above. Parent/Guardian (Print Name) *
Payment Options *
Questions
Please call or email with any questions or concerns. (240)-340-1635 or info@impackpak.com
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