** You MUST attend Towne Lake Academy to register for this class. **

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Child's Name *

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Last

Age *

School *

• Towne Lake Academy – North Campus – Wednesdays – 10:00am – 11:00am
• Towne Lake Academy – South Campus – Wednesdays – 3:00pm – 4:00pm

Parent / Legal Guardian's Name *

First

Last

Email *

Phone *

With your permission, we would love to capture and share moments from our program to showcase our activities. Photos and videos will be used in marketing materials, including our website, social media, and flyers. Do you consent to your daughter being photographed and filmed during class for marketing and promotional purposes of Shining Inspirations Inc. *

• Yes, I consent to my daughter’s picture and video being captured and shared for these purposes.
• No, I do NOT consent.

I understand Shining Inspirations Inc. is not a Towne Lake Academy program. This program has inherent risks for student injury and as the parent/legal guardian, I acknowledge and assume the responsibility of potential injury to my child. As the parent/legal guardian, I do not hold Towne Lake Academy responsible for any liabilities, judgements or damages as a result of participating in this program. *

• Yes, I understand and agree.
• No, I do NOT agree.

ballet and an

By signing your name below, you are providing an electronic signature, which holds the same legal effect and binding power as a handwritten signature, agreeing to all terms stated above. *

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Attire: Dancers will wear pink leotards, dance tights and pink ballet shoes to be provided by parent / legal guardian.

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Total *Ballet Class at TLA – $85.00

Payment Information *

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