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Parent/ Guardian Name *

First Name

Last Name

Student Name *

First Name

Last Name

D.O.B *

MM

DD

YYYY

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Class Times *

Thursday 9:30am Level 1 (2-3yrs)

Thursday 10:30am Level 2 (4-5yrs)

Tuesday 4:15pm Combine Levels

Terms and Conditions *

I the mother, father, guardian of the above agree that he/she shall enter the Clifton Dance Studio and undertake safe dance practices Clifton Dance Studio will show all care and due diligence but understand no liability will be taken for loss or damage, property or physical injury whist at Clifton Dance Studio. It is understood and agreed that all choreographic material taught at Clifton Dance Studio remains the property of Clifton Dance Studio and must not be performed, coached or viewed by other parties without the studios consent. I authorize Clifton Dance Studio to use my name and or photos/videos in all marketing materials including: Studio website, Dance Magazines, Advertisements, Concerting Programs and Social Media

I agree