Registration

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REGISTRATION

* Indicates required field

Dancer's Name *

First

Last

Dancer's Age *

10 11 12 13 14

Dancer's Birthday (mm/dd/year) *

Dancer's Address (Don't miss Praise Movement mail!) *

Line 1

Line 2

City

State

Zip Code

Country

Parent's First Name *

Parent's Last Name *

Parent's Contact Number (area code first) *

Parent's E-mail (Important Dance Break info will be sent here.) *

In case of an emergency, who should we contact? (#1) *

Phone Number (area code first) *

Relation to Dancer *

In case of an emergency, who should we contact? (#2) *

Phone Number (area code first) *

Relation to Dancer *

Does the dancer have any food allergies? *

Yes No

If yes, please explain in detail. *

Does the dancer have any serious illness(es) or medical condition(s) we should know about? *

Yes No

If yes, please explain in detail. *

Praise Movement School of Dance, Inc. believes that the word of God is the final authority by which our lives are governed. Hence, references to the word of God will be used inside and outside of dance instruction to teach Christian living principles and Christ-like behavior. For dance instruction, Praise Movement School of Dance, Inc. only uses music that uplifts the name of Jesus. The types of music we use are traditional gospel, contemporary Christian, and Christian rap. I understand Praise Movement School of Dance, Inc.’s beliefs and teaching principles. I understand that Praise Movement School of Dance, Inc. is operated by these beliefs and principles and that my child is expected to honor them as long as she is a participant. *

Yes No

Physical activity can sometimes cause minor mishaps to occur. Therefore, in the event a dancer sustains any injury, illness, or any other physical harm in connection with participation in the Praise Movement School of Dance, Inc. programs, I agree that neither the Praise Movement School of Dance, Inc, nor any of its instructors, employees, or agents shall be liable or responsible for any claims, costs, liabilities, expenses, or judgments (including, for example, doctor fees, hospital expenses, and personal injury claims resulting from any such injury, illness, or physical harm.) The acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. *

Yes No

I understand that all fees are non-refundable UNLESS Dance Break is cancelled by Praise Movement. In such instance, Praise Movement will issue a full refund of all paid fees. In the event that the dancer registered above is unable to attend or complete the 3-day session, I will inform Praise Movement School of Dance by phone or e-mail, and I understand that I will not receive any refunds. *

Yes No

Does your daughter have any specific English/Lang. Arts needs that you'd like us to address in the Dance Break 3-day session? Please explain. *

Please upload your daughter's 1st 9-week Progress Report OR Report Card. This is to verify age and to determine specific ELA instructional plans for our 3-day session. PLEASE MAKE SURE NAME, SCHOOL, AND GRADE ARE VISIBLE IN THE UPLOAD. *

Max file size: 20MB

Your registration is invalid without payment.
AFTER YOU CLICK "SUBMIT", YOU WILL BE AUTOMATICALLY REDIRECTED TO THE PAYMENT PAGE.

Submit

REGISTRATION

Your registration is invalid without payment. AFTER YOU CLICK "SUBMIT", YOU WILL BE AUTOMATICALLY REDIRECTED TO THE PAYMENT PAGE.

Your registration is invalid without payment.
AFTER YOU CLICK "SUBMIT", YOU WILL BE AUTOMATICALLY REDIRECTED TO THE PAYMENT PAGE.