EmailMe Form - Beautiful Ballet

Parent's Name *

First Last

Home Phone

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Email *

Mobile Phone *

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Child's Name *

First Last

Child's Age *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

How did you hear about this class? *

Informed Consent and Hold Harmless/Release Agreement:
I understand that participation in movement activities involves a certain degree of risk. I have carefully considered the risk involved and I understand that participation in these activities is entirely voluntary. By printing my name below, I release the Wil-‐Mar Neighborhood Center and Chelsea Moten from any and all claims of liability arising out of my child's participation in this class. Photos may be taken during a session and I allow these to be used for educational and marketing purposes. *

I have read and agree to the above statement.

Any comments or questions?