ViBeat Sign Up Form
Full Name or participant is Required.
Enter correct Name.

Gender:

Male Female
Age is Required.
Only Above 4 years Old are allowed.
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Email Address is Required.
Enter Correct Email Address.
Enter Correct Email Address.
Address is Required.
City and Province is Required.
Pin Code is Required.
Phone Number is Required.
Emergency Contact name is Required.
Emergency Phone Number is Required.
Relationship is Required.

Confirm that you agree to our LIABAILITY WAIVER, RELEASE AND INDEMNITY AGREEMENT:

Yes, I Agree NO

Photo Release:

I give permission for the student to be photographed and recorded in class while attending ViBeat Dance studio and events. ViBeat Dance may use these photographs and recordings in the future for archival and promotional purposes.

Yes NO
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