Trial Class Release Form

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We are so excited for you to join us for a class! Please fill this out before you arrive at the studio.

Student's Name: *

Gender: *

Female

Male

Date of Birth: *

YYYY

Class Type: *

Diaper Dancers | 1-2 yrs

Tiny Tots | 2-3 yrs

Preschool Dance and/or Preschool Tumbling | 3-4 yrs

Pre-K Dance and/or Pre-K Tumbling | 4-5 yrs

Ballet/Jazz Combo | STAR School-Age Program

Tumbling | School-Age

Hip Hop

Guardian Name: *

Street Address: *

City, Zip Code *

Phone Number (will receive text reminders periodically) *

Email: *

Emergency Contact Name: NOT THE SAME GUARDIAN AS LISTED ABOVE *

Emergency Contact Phone Number: *

By typing my name below I understand that there are specific risks of physical or property damages, losses, or injury that may result from me or my child's participation with Expressions Dance and Preschool and I voluntarily assume the risks associated with such participation. I release Expressions Dance and Preschool and all staff officials from all claims of damages or injury suffered by the registered family in connection with their association with Expressions Dance and Preschool. This includes my heirs who may not act in my behalf. * *

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