Dance Classes for Ages 5–6 | Petites Program at Impact Dance Center

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email *

Phone *

Dancer's First Name *

Dancer's Last Name *

Dancer's Date of Birth *

Born between September 2, 2019 and September 1, 2021

Dancer Gender *

Medical Conditions, Allergies, or Other Important Information *

Current Academic School

Current Grade *

Does your dancer have 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.

How did you hear about us? *

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

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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

Petites

Ages 5-6