Tiny movers & shakers

Registration form

Tiny Movers & Shakers Dance Class, where little feet get to explore the joy of movement! Please fill out the registration form below to secure your spot. Once you submit the form, Sarah will reach out via email to confirm registration and provide payment details.

We can’t wait to dance with you!

Student's Name

First Name

Last Name

Date of Birth

YYYY

Age of Child

School/Daycare

Primary Address

Phone

(###)

###

####

Parent/Guardian 1

First Name

Last Name

Address (if different from above)

Home Phone/Cell Phone

(###)

###

####

Parent/Guardian 2

First Name

Last Name

Address (if different from above)

Home Phone/Cell Phone

(###)

###

####

Emergency Contact 1 (other than guardian)

First Name

Last Name

Home Phone/Cell Phone

(###)

###

####

Emergency Contact 2 (other than guardian)

First Name

Last Name

Home Phone/Cell Phone

(###)

###

####

Photography Waiver (Check One)

I grant Sarah Daunt to use any photograph/film of me in brochures or other media for promotional purposes.

Yes

Liability Waiver I, the parent/guardian of the registrant, a minor, recognize the possibility of physical injury associated with training, and hereby release, discharge and/or otherwise indemnify Sarah Daunt against any claim by or on behalf of the registrant as a result of the registrant’s participation in classes at Wander located at 34 Depot St Suite 101, Pittsfield. Parents and caregivers are responsible for remaining inside at Wander while their child participates in the dance class. Please ensure you are observing your child at all times for a safe and enjoyable experience. I have read and understand all materials in this waiver and agree to abide by these terms. I am aware this is a waiver and release of liability and I sign it voluntarily.

Parent/Guardian Type Signature Here:

Today's Date

YYYY