EmailMe Form - ND&MA Trial Class 2026

Date *

MM / DD / YYYY

Class *

Dancer Name *

First Last

Date of Birth *

MM / DD / YYYY

Child DOB

Parent Name *

First Last

Email *

Parent email

Phone *

### - ### - ####

Parent phone

Phone type *

Cell

Home

Address *

Street Address City State / Province / Region Postal / Zip Code

Please help us get to know you by completing this survey prior to your arrival for your trial class at Neisha's Dance & Music Academy.

1. Current ND&MA student or previous dance/music experience: *

2. How did you hear about us? *

3. What is most important to you when choosing a dance or music school for your family? *

(Examples: fun, quality of instruction, supportive environment, performance opportunities, schedule flexibility, location, etc.)

4. What language is most comfortable for your child and family when communicating with our staff? *

We will do our best to support your preferred language whenever possible.

5. Is your child involved in other activities we should keep in mind when helping plan their schedule? *

(Examples: sports, tutoring, school programs, other arts activities, etc.)

6. How many performance opportunities would you ideally like your child to participate in? *

One recital at the end of the season

One recital plus occasional community performances

All of the above, plus dance competitions or ballet company performances

7. Which program(s) best matches what you are looking for?

A. Music Program

B. Recreational Dance Program or Young Children's Developmental Program

C. Young Children's Developmental Program or Strong Foundations Dance Program (Ages 8 and under)

D. Dedicated Dancer Program (Ages 9+)

E. Pre-Professional Program

Select all that apply. It's okay if none are a perfect fit—we can help customize your child’s path.

A. Music Program
Private lessons once per week
• 30 minutes for beginners
• 1 hour for intermediate/advanced

B. Recreational Dance Program or Young Children's Developmental Program
For children trying dance for the first time or taking 1–2 classes per week.

C. Young Children's Developmental Program or Strong Foundations Dance Program (Ages 8 and under)
Students building strong technical foundations.
Typically 2–3 classes per week.

D. Dedicated Dancer Program (Ages 9+)
Students seeking faster progress, more performance opportunities, and additional dance styles.
Typically 3+ classes per week.

E. Pre-Professional Program
For serious dancers training for college dance programs or professional careers (dance company, Broadway, teaching, etc.).
Examples include Chula Vista Ballet Company or competition teams.
Typically 6+ classes per week with a customized schedule.

8. Do you have any questions or concerns we can help answer before your trial class? *

For Music trials only:

Do you have an instrument?

Yes

No

If not, do you plan on purchasing an instrument in the next 2 weeks?

Yes

No

RELEASE

I hereby release Neisha's Dance & Music Academy, Inc. and its contractors from any claim for damage or suit by reason of injury, illness, virus, or damage to person or property during the course of the dance and/or music programs, including special events, and transportation to and from such events. In the case of emergency or sudden illness, I hereby give authority to any Hospital or Doctor to render immediate emergency aid as it might be required for the undersigned student's health and safety. Neisha’s Dance & Music Academy, Inc. DOES NOT carry medical insurance for its students. It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the student's own policy is your only source of reimbursement. I specifically intend this release to include all claims that my child and I might have based on actual or alleged negligence, supervision, instruction, training, and/or facility care and cleaning.

Signature

Clear

Your signature indicates you understand and agree to the RELEASE section above.

Please type parent name *

Please type student name *