2021 Winter/Spring Registration Form
impact performing arts                                                                      SS _______  
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Dancer's First and Last Name *
Dancer D.O.B *
MM
/
DD
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YYYY
Parent/Guardian First and Last Name *
Parent/Guardian Email *
Cell/Emergency Phone Number *
School Attending *
Current Grade *
How Did You Hear About Impact? *
Any Injuries or Illnesses? *
Dancer will be taking classes *
Showcase Semester
$70 costume fee for each performing class.
No refunds for costume fees.
Virtual and In-Person classes are able to perform in the showcase and will need a costume.
Non-performing classes are in blue on the schedule.

The plan is to have a showcase no matter what.  At this time we don't have a definite picture of what that will look like, but it will most likely be a mixture of in-person and virtual.  Details will be sent out as soon as they are available.
Class Selections
Please list class(es) below.
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

impact will not be issuing any credits or refunds for any registration fees for any issues, absences, closings related to or caused by Coronavirus/COVID-19.  IPA has a program in place to start virtual classes if necessary.
#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
#6 Day/Time/Class/Teacher
#7 Day/Time/Class/Teacher
Wavier
Participation in any Impact Performing Arts activity on or off-site and use of recreational facilities involves the risk of accidental injury despite all safety precautions.  Having been informed of the activities conducted by Impact Performing Arts, I/we, as an 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.

impact will not be issuing any credits or refunds for any registration fees for any issues, absences, closings related to or caused by Coronavirus/COVID-19.  IPA has a program in place to start virtual classes if necessary.

The printing of your name below will serve as your signature.

I agree to the wavier above.              Parent/Guardian (Print Name) *
Class/Payment Options *
Questions
Please call or email with any questions or concerns. (240)-340-1635 or impactdwx@gmail.com
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