Summer Series 2017 Registration Form

For Cultural Arts Center in Glen Allen and Dominion Arts Center

Name *
Date of birth
Date of birth
Phone *
Best way to contact you
Parent Name *
Parent Name
Address *
Which Series will you be attending?
Classes *
Which classes are you registering for?
We would love to hear how you heard about us!
Please list any health condition that we need to be made aware of, ie. asthma, past injury, etc.
Other Important Information
Emergency Contact *
Emergency Contact
Emergency Contact Information *
Emergency Contact Information
Misssed Classes *
Missed classes may be made up with any equivalent class of your choice.
Photography and Videography Waiver *
I understand that by signing this agreement I give permission for any photos or videos taken of myself or my child, while engaged in activities at the Latin Ballet to be used in promotional materials.
Responsibility Waiver *
I am aware the all forms of dance and gymnastics associated with, place unusual stresses on the body and may carry with them the risk of injury. I understand that the Latin Ballet of Virginia or its staff, are not liable in any way for injuries sustained during attendance of the program or any of its functions.