FREE TRIAL CLASS REGISTRATION Parent(s) Name(s)* First Last Child Name* First Last Child Date of Birth* MM slash DD slash YYYY Email* Cell Phone*Home PhoneAddress* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact Name* First Last Emergency Contact Number*Which location would you like to visit?* LAFAYETTE: 990 S. Public Road Lafayette, CO 80026 BERTHOUD: 345 Massachusetts Ave Berthoud, CO 80513 Select the Lafayette class you are registering for:* Baby Class on Thursdays | 12:00 - 1:00pm | April 6th - May 25th, 2023 | Lafayette Baby Class on Fridays | 12:00 - 1:00pm | April 7th - May 26th, 2023 | Lafayette Baby Class on Saturdays | 9:00 - 10:00am | April 8th - May 13th, 2023 | Lafayette Waddler Class on Wednesdays | 9:30 - 10:15am | April 5th - May 24th, 2023 | Lafayette Waddler Class on Fridays | 9:30 - 10:15am | April 7th - May 26th, 2023 | Lafayette Waddler/Toddler Class on Thursdays | 10:00 - 10:45am | April 6th - May 25th, 2023 | Lafayette Waddler/Toddler Class on Saturdays | 10:30 - 11:15am | April 8th - May 13th, 2023 | Lafayette WAITLIST ONLY Toddler Class on Wednesdays | 10:30 - 11:30am | April 5th - May 24th, 2023 | Lafayette Select the Berthoud class you are registering for:* Waddler Class on Tuesdays | 9:30am - 10:15am | April 4th - May 23rd, 2023 | Berthoud Toddler Class on Wednesdays | 10:30 - 11:30am | April 5th - May 24th, 2023 | Berthoud WAITLIST ONLY Baby Class on Wednesdays | 12:00 - 1:00pm | April 5th - May 24th, 2023 | Berthoud What Date Would You Like To Attend a Trial Class?* MM slash DD slash YYYY Please only select a date during scheduled session dates. How Did You Hear About the Free Trial Class?* Liability Waiver* By clicking here, you agree that you understand, agree, and accept this statement below. I agree to participation in the InsideOut Creative Movement programs for myself and my child(ren). I am aware that the activities of creative movement involve risks of injury and freely assume those risks for myself and my child(ren).I hereby release InsideOut Creative Movement programs from any legal liability and agree not sue its owner and or Tara Cluck Dance Center for any and all injuries caused by participation in the class. CommentsThis field is for validation purposes and should be left unchanged. Δ