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

Email *

Your Name *

Phone Number *

Will a caregiver, other than yourself be dancing with your child?

Which Class would you like to drop into? *

Mondays 9:30-10:15AM 0-3: $20

Tuesdays 3:30-4:15PM 0 - 3: $20

Wednesdays 9:00-9:30AM 0 - Crawlers: $20

Wednesdays 9:45-10:30AM Walkers: $20

Wednesdays 10:45-11:30AM Creative Moments ages 2-3 (little ones only): $20

How did you hear about the class?

What date would you like to attend class? *

YYYY

Child's Name *

Child's Birthday *

YYYY

By signing below, I do hereby release Ann Brodie's Carolina Ballet Center For Dance Education and their agents or representatives of liability for my child (or myself) of any injury to my child (or myself) in class, while on the school campus, or while participating in CDE sponsored events/ activities/ performances. I understand that in the event medical intervention is needed, every attempt will be made to contact the person (s) listed on the registration form. In the event next of kin cannot be contacted for the health and well being of my child (or myself), I hereby authorize the Direct or Instructor or Staff of CDE to authorize whatever medical treatment that might be necessary in an emergency situation. I understand that I or my medical insurance carrier are financially responsible for any medical treatment extended to my child (or myself), and that CDE and its agents or representatives cannot be held accountable or liable for such medical treatments.
*

I acknowledge and agree to the above terms

Required

I understand that photographers, videographers and/or television crews may sometimes be present photographing or filming rehearsals, classes and presentations. I give my permission for resulting photographs and/or television/film footage that may include myself/child to be used for promotional purposes on television, newspapers, programs, magazines, or any other media

I acknowledge and agree to the above terms

Anything else we should know about you or your family?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms