First Name *

Last Name *

Email *

Phone *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship *

Emergency Contact Phone *

Medical Conditions, Allergies, or Other Important Information *

Do you have previous experience? *

Choose your first class below. Classes marked with an * are designed for students with 1-2 years previous experience.

Adult Ballet 18+ Sat 10:00 AM CYP A with Carri

Adult Jazz Beg 18+ Mon 5:30 PM CYP C with Carri

Adult Jazz Int 18+ Mon 7:30 PM CYP C with Carri*

Adult Lyrical 18+ Sat 11:15 AM CYP A with Carri

Adult Pilates Fusion 18+ Fri 10:45 AM LOS AL 3 with Annie

Adult Tap Beg 18+ Mon 7:30 PM CYP B with Nancy

Adult Tap Adv Beg 18+ Wed 7:30 PM CYP C with Shawn*

Adult Tap Int 18+ Mon 6:30 PM CYP C with Carri*

Classes marked with an * are designed for students with 1-2 years previous experience.

When would you like to attend the class you selected above? *

Your pass will be active for seven consecutive days beginning on the date you choose.

Would you like to try additional classes during your 7-day pass? (Optional. You may select more than one.)

Adult Ballet 18+ Sat 10:00 AM CYP A with Carri

Adult Jazz Beg 18+ Mon 5:30 PM CYP C with Carri

Adult Jazz Int 18+ Mon 7:30 PM CYP C with Carri*

Adult Lyrical 18+ Sat 11:15 AM CYP A with Carri

Adult Pilates Fusion 18+ Fri 10:45 AM LOS AL 3 with Annie

Adult Tap Beg 18+ Mon 7:30 PM CYP B with Nancy

Adult Tap Adv Beg 18+ Wed 7:30 PM CYP C with Shawn*

Adult Tap Int 18+ Mon 6:30 PM CYP C with Carri*

Classes marked with an * are designed for students with 1-2 years previous experience.

How did you hear about us? *

If you were referred by a friend, please write their first and last name below

By submitting this form, you consent to receive SMS messages and emails from our company. To unsubscribe, follow the instructions provided in our communications. Message frequency varies. Msg & data rates may apply for SMS. Your privacy is our priority. Your information will not be shared.

Impact Dance Center Participation & Safety Agreement

By checking this box, I acknowledge that entering, observing, or participating in activities at Impact Dance Center involves the ordinary risks of dance and studio activities, including slips, falls, collisions, muscle strains, sprains, overuse injuries, and contact with floors, equipment, instructors, or other participants. I voluntarily assume these risks and, to the fullest extent permitted by California law, release and waive claims against Impact Dance Center, its owners, instructors, employees, agents, contractors, and volunteers for injury, illness, death, property damage, or loss arising from the Participant’s presence or participation, including claims based on ordinary negligence. This release does not apply to gross negligence, reckless or willful misconduct, intentional acts, fraud, or violations of law. If the Participant is under 18, I confirm that I am the Participant’s parent or legal guardian and am authorized to sign on the Participant’s behalf.

7-Day Class Pass Request

Adults

Ages 18+