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Cell Phone for Text Messages

Email Address

I give permission to Kauai Dance Center for photographs & film to be taken

Parent/Adult Performer

First Name

Last Name

Other Phone

Student / Child Performer

First Name

Last Name

Dance Class Level

I understand that my child is performing in a public event.

I understand that my child's image may appear in promotional material for Kauai Dance Center and dance program literature. I understand that I will not receive compensation for the use of the image(s)

Kauai Dance Center reserves the right to refuse dance classes to anyone.

Note: Disruptive behavior harms us all. Should we meet an unfortunate situation with a student or parent where the behavior causes a disruption of a class, and causes concern beyond what is reasonable to work with, the student & parent will be asked to leave the program.

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Parent / Adult Signature

Student Signature

Sponsor Signature (if applicable)

Comments, Questions


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