Student Name *

First Name

Last Name

Parent/Guardian Name (if applicable)

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Class Desired *

Pre-K Class

Elementary Class

Nonstop Dance Company Class

Carbon Civic Ballet Class

Adult Tap Class

Release *

I, the undersigned, have read and understand the policies and procedures of Moving Art Academy, LLC and agree to abide by them as long as the above student is enrolled. Student and parent/guardian understands and expressly assumes all risk of bodily injury occurring as a result of contact with other students, instructors, structures, equipment and other objects located on studio property, or the student’s physical condition or limitations, participant waives all claims arising out of any and all activity associated with Moving Art Academy, LCC, whether caused by negligence, breach of contract, or otherwise, and whether for bodily injury, property damage or loss or otherwise, which student may ever have against Moving Art Academy, LLC, its directors, instructors, employees and administrators.

I give Moving Art Academy, LLC permission to use photos of my student for promotional purposes in either print or electronic formats.

New students are required to pay a $20.00 non-refundable registration fee due before the first day of class.