Industry Night Registration

Industry Night Registration

Use this form to register for one or more of our Industry Nights!
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Student Name*

First NameLast Name
Student Date Of Birth*

MonthDayYear
Date
Conditions requiring special consideration (medical/physical)
Upcoming Industry Nights
I would like to sign up for the following Industry Nights*

Oct 29 - Lukky - HipHopNov 19 - Makaihlah Stover - ContemporaryJan 28 - Dylan Phanthavong - HiphopFeb 25 - Jaden Miller - Contemporary Fusion
Level*

Beginning (ages 9-12)Intermediate (ages 11+)Advanced (ages 14+)
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I hereby understand and acknowledge that the training, programs and events held by Dance Expressions, may expose my child to many inherent risks, including accidents, injury, illness or even death. As the parent, I acknowledge my responsibility in communicating any physical and/or psychological concerns that might conflict with my child participating in this activity.

I further agree to indemnify and hold harmless and defend Dance Expressions, its teachers, officers, agents, and employees from any and all claims for injuries, damages and losses sustained by me, my child or family, arising out of, connected with, or in any way associated with the activities of the program(s). I have read and fully understand the above program details and waiver and release of all claims.
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Upcoming Industry Nights