Dancer Intake Form

Please review the IAC Waiver and fill out the information below.

Dancer Information

Birthday required

Home Park District

Guardian 1 Information

Guardian 2 Information

Guardian 3 Information

Please inform IAC if any medical information taken may affect their time in dance class.

Allergies

Current Medications

Healthcare Provider & Phone Number

Please list any past or current physical limitations, injuries, and/or weaknesses that may affect the dancer:

Please list any sensory sensitivities the dancer may have:

If the dancer has a condition that may require special attention during class, please list with directions below (such as use of inhaler, insulin, etc.):

Click Here to View Participation Waiver

In signing this agreement, I acknowledge and represent that I have read and understand this Waiver of Liability Agreement. I hereby release Innovation Arts Connection from any and all liability described in the above. I agree to all above terms and grant permission for the participant to participate in Innovation Arts Connection classes and events.

Your Signature

Your dancer intake form has been received! The IAC team will contact you if we have any questions. Thank you!