Ariel Dance Productions :: Registration

Class Registration Form

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Thank you for your registration!

Student First Name *

Student Last Name *

Age *

Street Address*

City*

Zip Code*

Phone Number*

Email*

Current Occupation (if in school please enter school name)

What class(es) do you wish to register for?

Class Name*

Class day*

Class Time*

Class Name 2

Class Day 2

Class Time 2*

Class Name 3*

Class Day 3

Class Time 3

Class Name 4

Class Day 4

Class Time 4

Please list 2 emergency contacts

Name *

Phone Number*

Relation*

Name

Phone Number

Relation

Medical Conditions

Dance training

Leave this field blank: Do not label this field:

What classes would you like to see offered at our studio?

How did you hear about Ariel Dance Productions?

Insurance Waiver

Any dancer participating in a dance class takes certain incumbent risks. These include, but are not limited to, sprains, pulled muscles, and broken bones. Participation in Ariel Dance Productions indicates the acceptance of such risks. Ariel Dance Productions and the host venue assume no responsibility for personal injury or property lost at its events. I will not hold the Ariel Dance Productions responsible in case of accidents or injuries that occur during dance class or performances.

Terms and Conditions

There are NO REFUNDS, CREDITS, MAKE UP OR EXTENSIONS for missed classes.

I have read and agree to the Insurance Waiver and Terms & Conditions

* Required

Registration Form design: www.marliesreiha.com

Ariel Dance Productions, LLC
2385 S. Winchester Blvd. Campbell, CA. 95008
408-621-2790 - info@arieldanceproductions.com