Please fill out the form

    1. Dancer’s Name
    2. Current Grade/Age:
    3. D.O.B.:
    4. Cell. No.:
    5. Address:
    6. List any allergies, medical concerns and/or restrictions you believe we need to know about the dancer while participating in any of our dance activities::
    7. Parent’s/Guardian’s Info.: MomDadGuardian
    8. Name:
    9. Cell Number
    10. Email:
    11. Parent’s/Guardian’s Info.: MomDadGuardian
    12. Name:
    13. Cell Number
    14. Email:
    15. EMERGENCY CONTACT: If parents/guardians cannot be reached, please
    16. Person 1:
    17. Person 2:
    18. SPECIAL NOTES: (Is there any necessary, important information we need to know about your dancer?)

      Participating in dance class or any related event always runs the risk of personal injury and loss or theft of personal property. The purpose of this acknowledgement is for you to understand that there is a possibility of personal injury or property damage beyond the control of Eastside Dance Project LLC, employees /independent contractors. Eastside Dance Project LLC, its employees/independent contractors is/are not responsible for personal injury and loss or theft of property. By signing this form you are acknowledging that you have read and understand the risks and liabilities of participation.


      I further authorize Eastside Dance Project LLC to seek medical treatment at the nearest medical facility and they may call paramedics and discharge me/my student to an ambulance if I am not able to authorize it, in the case of an emergency. I certify that my child/dancer is in good health and capable of participating in physical activities.


      I hereby give my permission to Eastside Dance Project LLC to take and use photographs for promotional uses for the studio.


      I understand that payment is non-refundable.

    23. I have read this document in its entirety, and sign below as I am in agreement with Eastside Dance Project LLC’s policies. I further certify that the information I have provided on this form is all accurate and true to best of my understanding and knowledge. I hereby sign this document understanding I am entering into contract with Eastside Dance Project, LLC.

    24. Date:
    25. Parent/Guardian Signature(if minor):
    26. Signature: