Dancer's Name *

First Name

Last Name

Dancer's Phone

Country

(###)

###

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Dancer's Date of Birth *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Parent's Phone

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Teacher/Studio Phone

(###)

###

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Referral Name

If you were referred by a friend, capture it here!

First Name

Last Name

How did you year about IDA?

From a Friend

Performance

Poster

Online

Radio

Social Media

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