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_______________

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© 2015 by The Lori Allen Dance Center

Where Children Can Reach Their Goals and Fulfill Their Dreams