Thursday 7:00 p.m.
Modern / Jazz
October 20th to November 17th
$75.00 Session - $16.00 single class
Minimum 5 dancers - Must pre-register  - Drop-in welcome - must pay prior to class
Fill out and submit  the form below.  
For  more information email:  admin@coastcityballet.com
*required fields
RELEASE OF LIABILITY
if under 18
Please make your payment via the Pay Pal button below and then click the submit button to submit registration.
or fill PDF form and return via email to: admin@coastcityballet.com    Thank you
I understand that  my  (my child’s ) participation is voluntary, and I agree that Coast City Ballet-Pacific Dance Center their past, present and future
officers, employees, contract teachers, agents, representatives, successors assigns, insurers  are not liable for any harm, bodily injury, or damage
that may occur.

I grant to Coast City Ballet-Pacific Dance Center the right to take photographs and videos of me (my child) in connection with the above-identified
activity  I agree that Coast City Ballet-Pacific Dance Center may use such photographs and videos of me (my child) with or without my name and
for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content whether in print and/or
electronically.

I hereby release Coast City Ballet-Pacific Dance Center and their past, present and future officers, employees, contract teachers, agents,
representatives, successors, assigns, and insurers from any and all liability, loss, damage, costs, claims and/or causes of  action, including but
not limited to all bodily injuries, damages or loss of property arising out of participation in classes or activities.      

I understand this waiver may be used in a legal action against the undersigned and/or representative filing claims on their behalf
                                                                                                                      
By submitting this form I agree to follow Coast City Ballet~Pacific Dance Center Studio Policies.
Modern-Jazz
9596 Hamilton Ave - Huntington Beach, CA  92646
714-963-9771
admin@coastcityballet.com - pdc@coastcityballet.com