2025 Junior Registration (Ages 5-13)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Before filling out the form please make sure that you have read and are familiar with the following documents:

Fill the form for each dancer.

Code of conduct *

I have read and agree to conduct myself in accordance with the code of conduct.

YES

Rules and Requirements *

I have read and understand the rules and requirements for participating in the Polanie Dance Group activities.

YES

Liability *

I have read, understand and agree with the contents of the liability waiver. Despite precautions, accidents and injuries may occur. By registering for classes and paying the class fees, you agree to be bound by this waiver.

YES

Media Release *

Upon registration, implied consent is given to use any photographs taken for use in studio publications including the Polanie website or other electronic forms of media. If you do not consent please select NO

YES

Parent / guardian First and Last Name *

Email *

All group related communications will be delivered to this address.
If entering multiple email addresses separate them by commas.

Phone Number *

Please provide phone number or numbers of the people who will be dropping or picking up the dancer.

Dancers Name *

First and last if the last name is different from registering parent guardian.

Age as of December 15th *

Gender *

For the purposes of costumes.

Important Considerations *

Allergies, medical conditions, other information relevant to participation in a dance class.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Polanie Dance Group.

Does this form look suspicious? Report

Forms