BDC Free Trial Class 
Please fill out the form below to register for a free trial class
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Student Name *
Student Birthdate *
MM
/
DD
/
YYYY
Parent/Guardian Name
Primary Phone Number *
Email Address *
Emergency Contact Name/Phone Number *
Please list any allergies or medical conditions we need to know about
I/we give media use rights permission *
To my knowledge, my child does not have any medical problems that would prevent him/her
from participating in a dance program. I understand that it is my responsibility to obtain a
physician's consent if necessary and inform instructors of health problems. In the event of an
accident or injury during this program or any organized event that results from the program, I
will not hold the instructors or the organization Beyond Dance Company responsible for injury. I
release all such parties, including the landlord and owners of The Christian Education Center
from any liability. *
Required
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