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 session would you like to attend?* LAFAYETTE (Weekday): TCDC 990 S. Public Road Lafayette, CO 80026 LAFAYETTE (Saturdays): TCDC 990 S. Public Road Lafayette, CO 80026 Select the Lafayette (Weekday) class you are registering for:* Baby Class on Fridays | 12:00 - 1:00pm | November 1st - December 13th, 2024 | Lafayette (No Class Nov. 29th) Waddler Class on Tuesdays | 9:30 - 10:15am | October 29th - December 10th, 2024 | Lafayette (No Class Nov. 26th) Waddler Class on Wednesdays | 9:30 - 10:15am | October 30th - December 11th, 2024 | Lafayette (No Class Nov. 27th) Waddler Class on Fridays | 9:30 - 10:15am | November 1st - December 13th, 2024 | Lafayette (No Class Nov. 29th) Toddler Class on Tuesdays | 10:30 - 11:30am | October 29th - December 10th, 2024 | Lafayette (No Class Nov. 26th) Toddler Class on Wednesdays | 10:30 - 11:30am | October 30th - December 11th, 2024 | Lafayette (No Class Nov. 27th) WAITLIST ONLY Toddler Class on Fridays | 10:30 - 11:30am | November 1st - December 13th, 2024 | Lafayette (No Class Nov. 29th) Select the Lafayette Saturday class you are registering for:* Baby Class on Saturdays | 9:00am - 10:00am | November 2nd - December 14th, 2024 | Lafayette (No Class Nov. 30th) Waddler/Toddler Class on Saturdays | 10:30 - 11:15am | November 2nd - December 14th, 2024 | Lafayette (No Class Nov. 30th) 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, Berthoud Dance Company, Michelle Latimer Dance Academy for any and all injuries caused by participation in the class. EmailThis field is for validation purposes and should be left unchanged. Δ