Student Name *
Student Name
Date of Birth *
Date of Birth
Parent/Guardian Name *
Parent/Guardian Name
Cell Phone *
Cell Phone
Payment is due upon first class. Please bring in or drop off payment to studio.
Lincoln Park Dance and Move Waiver *
I certify that the above information about my child (medical conditions, allergies, pre-existing injuries, concerns) is correct. I will not hold Lincoln Park Dance and More, LLC (or employees) accountable for any injuries or lost/stolen items. By checking the below, I authorize the use of my child's photos for promotional and advertising purposes. I understand that there are no refunds for term payment once submitted.
Select one of the below: