Name *

First Name

Last Name

Which class(es) are you interested in trying? *

ADULT TAP

BALLETFIT

DANCEFIT

Do you suffer from any injury/illness that you feel we should be aware of? *

YES

NO

Lucy Robins - Ballet Fit with Lucy/Dance Fit with Lucy (Lucy Robins School of Dance) take all precautions to ensure the safety of everyone involved. I will not hold Lucy Robins/Lucy Robins School of Dance liable for any injury, loss or damage which may be sustained as a result of participating. Participant agrees that s/he is physically, mentally and emotionally able to use the equipment, facilities and to take part in the activities offered. Participant understands that all of the steps, movement and patterns are designed so that they are simple to follow and carry out but that they are still able to work at their own pace, taking a break whenever they feel necessary. *

I ACCEPT AND AGREE

I hereby for myself, any heirs, executors, administrators or anyone else who might claim on my behalf, contract not to sue. I waive, release and discharge Lucy Robins/Lucy Robins School of Dance, its staff, agents, subcontractors and representatives of all liability, claims, damage, costs or expenses which I may have against them arising out of or in connection with my participation in the classes. This release extends to all claims of any kind what so ever, foreseen or unforeseen, known or unknown. *

I ACCEPT AND AGREE

I give permission for photographs and/or videos to be used on LRSD website and social media. *

YES

NO

Information collected by this form will be held for a limited time in accordance with GDPR. From time to time LRSD would love to let you know about upcoming events, workshops, shows, competitions, offers and other school news. Full details on how we use data can be found in our privacy policy. I consent to having LRSD collect my name, phone number & email address. Please choose how you would like to stay in contact with LRSD * *

EMAIL

TEXT MESSAGE

PHONE

I confirm that the above information is accurate to the best of my knowledge and hereby give consent for the information to be shared with LRSD staff. *

I AGREE AND COMPLY