Dancer's name *

First Name

Last Name

Parent's name

If the dancer is under 18 years old, please provide a parent or legal guardian's name.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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How did you hear about Island Dance Academy?

Performance

Posters

Yellow pages

Newspaper

Radio

Friend

If a friend referred you to I.D.A, please share their name

First Name

Last Name

Injury Waiver *

As legal guardian of the dancer registering or as the dancer registering who is at least 18 years of age, I hereby assume the risk of any injuries or the loss of any property that may occur while receiving instruction from or performing with Island Dance Academy, hereafter I.D.A. I will not hold I.D.A., its staff, or its venues responsible for any personal injury or loss of property that may occur while receiving instruction from or performing with I.D.A.

I agree with the above statement.

I do not agree with the above statement.

Media Release *

I give permission for photos of the dancer to be used without compensation by IDA for promotional purposes.

I hereby give permission.

I do not give permission.