Schedule a Free Trial Class

Free Trial Class

Join us for a free trial class. No commitments, just fun! Please fill out the form below to get started.

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Student Name *

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Student Age *

DATE OF BIRTH *

Parent Name *

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Primary Email *

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Preferred Contact Method *

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How did you hear about us? *

Which class(es) is your child interested in trying (Please include dates & times)? *

Does your child have any previous dance experience? If so, please list below. *

Momentum Dance Center, Inc.
Liability Waiver & Acknowledgement of Risk

By submitting this form, I understand that I am giving permission for my child to participate in classes at Momentum Dance Center. I understand that by allowing my child to participate in any dance class, there is a possibility of physical injury. I voluntarily agree, therefore, to assume all risks and responsibility for such injury or accident, which might occur to my child during any class at Momentum Dancer Center. I also exempt, release and indemnify Momentum Dance Center, its owners and agents from any and all liability claims, demands or causes of action whatsoever from any damage, loss or injury to my child or damage of property which may arise out of or in connection with participation in any classes or activities conducted by Momentum Dance Center. I understand that I should be aware of my child's physical limitations and agree not to exceed them.

I've read and agree to the statement above. *

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I agree to receiving marketing & promotional materials from Momentum Dance Center. *

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