New Student Information

This information will help us provide you with the best possible lesson experience and get you out on the dance floor having fun as soon as possible! Thank you for completing this form in advance of arrival at our studio.

Your Name (required)

Your Email (required)

Join our email list? (required)
YesNo

Cell Phone Number (required)

OK to text? (required)
YesNo

Birthday (day/month)

City

Best time for lessons?
AfternoonEveningWeekends

How did you hear about us?

Do you know which dances you are interested in?

What are your dance goals?

Emergency contact (name, phone, relationship)

Photo Release -- You give Spotlight Ballroom the right and permission to use your photograph in its promotional materials and publicity efforts. You understanding that the photographs may be used in a publication, print ad, direct-mail piece, electronic media or other form of promotion.

Release of liability --
I, the undersigned, acknowledge that I have voluntarily applied to participate in dance instruction and/or fitness training at Spotlight Ballroom (“Spotlight”). I am aware that dance and fitness training poses inherent risks of injury and is a potentially hazardous activity. I should not participate in dance and fitness training activities unless I am medically able. I agree to abide by any decision of an employee or representative of Spotlight relative to my ability to safely participate in any dance or fitness activities. I assume and understand all risks associated with participating in the dance and fitness activities of Spotlight, including but not limited to falls, contacts with other participants on premises, and the conditions of the dance floors or other surfaces whether on Spotlight’s premises or elsewhere. I am voluntarily participating in these activities with knowledge of the danger involved, and I hereby agree to accept any and all risks of injury.
As consideration for being permitted by Spotlight to participate in these activities and use its facilities, I hereby agree that I, for myself and anyone entitled to act on my behalf, waive and release Spotlight, their representatives, and successors, from all claims or liabilities of any kind arising out of my participation in these activities even though that liability may arise out of negligence or carelessness on the part of Spotlight.
Full name signing agreement to release of liability and photo release. (required)