Step 2

Step 2:

Tell us more about you and your dancer to submit your request

Please complete the form below

First Name *

Last Name *

Email *

Phone *

Student First Name *

Student Last Name *

Student DOB *

Ages 2-4 *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

*

Any limitation in ability to participate due to a medical condition MUST be noted on THIS FORM. Failure to note such condition is warranty that such condition does not exist. In the event of accident or illness of the child listed above, I will be notified immediately. In the event I cannot be contacted, I hereby authorize Alta Loma Dance Academy to take any steps necessary to make medical attention available, including physician, hospital, or any other medical services and I further agree that the cost of such medical services shall be borne exclusively by myself. In consideration of my participation in Alta Loma Dance Academy training, I hereby release Alta Loma Dance Academy, any Studio Owner, any Studio instructor, assistant, employee, or volunteer from any liability now or in the future including but not limited to muscle strains, pulls, or tears, broken bones, shine-splints, foot injury, heart attack, and any other illness or injury occurring during or after participation in the dance program.

Add your payment info, then click the button below. (You can sign up an additional student if needed on the next step.) *

Trial Class - 1 Student

$15