Dancer’s Name *

First Name

Last Name

Dancer’s D.O.B *

MM

DD

YYYY

My dancer is registered for the following class: *

Hip Hop (AGES 7-12) @ U-District

Breakdancing (AGES 7-12) @ U-District

Dance Basics. (AGES 5 + 6) @ Capitol Hill

K-Pop (AGES 7-9) @ U-District

K-Pop (AGES 10-12) @ U-District)

K-Pop (AGES 13+) @ U-District)

Private Class

Primary Contact *

First Name

Last Name

Phone # *

Primary Contact

(###)

###

####

Emergency Contact *

First Name

Last Name

Phone # *

Emergency Contact

(###)

###

####

Do you give permission for your teen to leave without a parent/guardian signing them out? *

if your dancer is in our younger age group classes, please answer N/A

YES

NO

N/A

Do you give PopRox permission to use your dancer’s image in future marketing materials? *

YES

NO

BEHAVIOR POLICY *

Being a kid ain’t easy and we totally understand. Here at PopRox we employ a three strike rule. Difficult days happen and when they do we remain in constant communication with our dancer’s parents so we can work on any challenges we may experience together. Our ultimate goal is to create a fun and creative class experience for ALL dancers and instructors. If any dancer continues to disrupt other student’s experiences or struggles with our class rules, and two warnings have been issued (to both kid and grownup) we will ask for the dancer to no longer attend our classes, with no potential for a refund. This policy is to protect all of our dancer’s experiences equally and we ask that you clearly communicate this policy to your kid before classes begin.

I have read, understand and agree to this policy

Date: *

MM

DD

YYYY