Summer Dance
Trolls
June 22nd-25th 6:00-8:00
Hip-Hop,
Leaps, Jazz, Tumbling and Pitt Dance Team!!
July 20th -23rd 6:00-8:00
PRICE: $85/ DANCER
Student Name ________________________________________ Age _____________Birth date_________
Parent’s Name Mother__________________________________Father____________________________
Address ____________________________________________________________Zip Code______________
Home Phone ___________________Parent Cell Phone 1 Cell Phone 2____________
Emergency Name and Number ___________________ E-mail: ________________________
*PLEASE CALL ME AT 724-745-9470 IF YOU HAVE ANY QUESTIONS*
PLEASE SIGN AND DATE WAIVER
I Understand that the dance instruction given to my child,_______________________,is a vigorous
Physical activity which may result in injuries to my child. In consideration of the enrollment of my child,
I hereby release the owners, directors, employees, affiliates and agents of The Lori Allen Dance Center
And the owners of the premises upon which any class, rehearsal or any performances is held from any
And all causes of action, claims for damages and expenses related to or arising out of any accident, injury
Or loss of property related to my child’s instruction or participation in any activity related to the
Lori Allen Dance Center. Signature______________________________ Date_______________
.
© 2015 by The Lori Allen Dance Center