Registration

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* Indicates required field

Dancer's Name *

First

Last

In which city will the dancer attend the tour workshop? *

Are you the parent or legal guardian of the dancer who will attend the tour workshop? *

If NO, please stop here. A parent or legal guardian must complete the registration form.

If NO, please stop here. A parent or legal guardian must complete the registration form. Have the parent or guardian come back later to complete the form.

Dancer's Age *

10 11 12 13 14 15 16

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

Dancer's Address *

City *

State *

Zip Code *

Parent's First Name *

Parent's Last Name *

Parent's Contact Number *

Parent's Email (IMPORTANT tour info will be sent here) *

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

Phone Number (Emergency #1) *

Relation to Dancer *

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

Phone Number (Emergency #2) *

Relation to Dancer *

Please upload Proof of Age for the dancer where her name and birth date are CLEARLY PRINTED. (i.e. birth certificate, medical statement, standardized test results) --- JPG (picture) is the best format. *

Max file size: 20MB

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. *

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, agents, or principles shall be liable orresponsible 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

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 and praises God. The types of music we use are traditional gospel, contemporary Christian, and Christian rap. I have read the above statements, and 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

I understand that the sessions may be changed, cancelled, combined, or rescheduled as required. In the event that the dancer registered above decides to discontinue the session, I will inform Praise Movement School of Dance by phone or e-mail. *

Yes No

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