Trial Class Form
Please fill out the form below to start your trial class process.  If you have any questions, contact Uplift Dance at 224-828-0801 or upliftdanceducation@gmail.com
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Email *
Where did you hear about us?
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Phone Number
 *
Parent's First & Last Name
*
Dancer's First and Last Name
 *
Student's Birthday & Age
 *
 
Address
 *
Today's Date
 *
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Use of child photo on Uplift Dance Education social media and website *
Emergency Contact & Phone Number *
 
Health Conditions or Allergies
*
Parent/Guardian/Adult Participant Initials:
 I hereby give consent for the above named person to participate in dance and/or other physical activities under the direction of Uplift Dance Education
*
Class Options

Classes Run June 3rd- August 2nd.
Studio is Closed June 28th- July 7th
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A copy of your responses will be emailed to the address you provided.
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