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Request a Trial Class

Ages 6-9
After submitting this form, a member of our staff will be in contact with a date to take your trial class.

Select a class

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.

Note any medical conditions here

Time Limit Reached