New Student Registration Form

This form below is for internal Art in Motion PGH use only and all information will be held confidential, not shared with any other entity. We value your privacy!

Dancer's Name(required)

Email(required)

Address & Phone Number

Dancer's Date of Birth(required)

Studio Policy: I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Art in Motion Pittsburgh, LLC classes, rehearsals, performances, or activities. I also exempt, release, and indemnify Art in Motion Pittsburgh, LLC, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Art in Motion Pittsburgh, LLC. All tuition is NON –REFUNDABLE, NON-TRANSFERABLE and due by the end of the first week of every month. PLEASE see Ms. Jen or Ms. Lucy about payment options. Please initial below.(required)

Your Signature and date (Parent or Guardian if under 18 years of age)(required)

Emergency Contact Name & Number(required)

I allow Art in Motion Pittsburgh to photograph my child/myself in classes and showcases and to use for promotional purposes. Please initial if you agree.(required)

Please list any allergies or medical conditions we should know about your child EXAMPLE: Asthma, Peanut allergy etc:(required)

Which class are you interested in?(required)

Art in Motion Pittsburgh

an international dance studio

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