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Name:

* required

Last Name:

* required

Birth date (mm/dd/yyyy):

Age:

Parents Name:

Phone Number:

Cell Number:

Address:

Your address here.

Mailing List:

Please add me to your student mailing list.

Email:

* required

Session:

1st Choice Class Selection:

Day:

Time:

Please select an alternate class choice. This can mean a different time for your first class choice.

2nd Choice Class Selection:

Day:

Time:

LIABILITY WAIVER

As the parent/guardian of the above mentioned child, I am aware that any physical movement program could result in injury and I permit my child to participate in such a program and release LimeLight Dance Studio, Diva Dancewear, its owners, employees and staff from all liability for injury, from his/her participation in the program. I also agree to allow LimeLight Dance Studio and Diva Dancewear to use photographic image or video of my child (without identification) for advertising or promotional purposes. As the parent/guardian of he above mentioned child, I have read and understand the terms of this agreement and will abide by the above mentioned guidelines.

I accept the terms of this agreement and will abide by the above mentioned guidelines.

Please hit the "SUBMIT" button once you have completely filled out this form. Incomplete forms will not be accepted.