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 (Weekday): TCDC 990 S. Public Road Lafayette, CO 80026 LAFAYETTE (Saturday): TCDC #2 1304 Centaur Village Dr. Lafayette, CO 80026 BERTHOUD: 345 Massachusetts Ave Berthoud, CO 80513 CENTENNIAL: MLDA 8985 E Nichols Ave Suite 300, Centennial, CO 80112 Select the Lafayette (Weekday) class you are registering for:* Baby Class on Fridays | 12:00 - 1:00pm | April 12th - May 17th, 2024 | Lafayette Waddler Class on Tuesdays | 9:30 - 10:15am | April 9th - May 14th, 2024 | Lafayette Waddler Class on Wednesdays | 9:30 - 10:15am | April 10th - May 15th, 2024 | Lafayette Waddler/Toddler Class on Thursdays | 9:30 - 10:15am | April 11th - May 16th, 2024 | Lafayette Waddler Class on Fridays | 9:30 - 10:15am | April 12th - May 17th, 2024 | Lafayette Toddler Class on Tuesdays | 10:30 - 11:30am | April 9th - May 14th, 2024 | Lafayette Toddler Class on Wednesdays | 10:30 - 11:30am | April 10th - May 15th, 2024 | Lafayette WAITLIST ONLY Toddler Class on Fridays | 10:30 - 11:30am | April 12th - May 17th, 2024 | Lafayette Select the Lafayette class you are registering for:* Baby Class on Saturdays | 11:45am - 12:45pm | March 16th, 2024 | Lafayette Baby Class on Saturdays | 11:45am - 12:45pm | April 13th - May 18th, 2024 | Lafayette Waddler/Toddler Class on Saturdays | 9:30am - 10:15am | April 13th - May 18th, 2024 | Lafayette Waddler/Toddler Class on Saturdays | 10:30 - 11:15am | April 13th - May 18th, 2024 | Lafayette Select the Centennial class you are registering for:* Waddler/Toddler Class on Mondays | 10:15am - 11:00am | January 22nd - March 4th, 2024 (No Class 2/19) | Centennial Baby Class on Mondays | 11:45am - 12:45pm | January 22nd - March 4th, 2024 (No Class 2/19) | Centennial 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. NameThis field is for validation purposes and should be left unchanged. Δ