Membership Info | Mountain Movers Crea

Phone: 540-750-0098

Address: 1794 Apperson Dr. Salem, VA

Valley Commons

AcroDance Preschool Certification no bkgnd.jpg

Class Schedule

Parent Portal/Parent Registration

Address: 1794 Apperson Dr.

Salem, VA

Valley Commons

Participant-Membership Application

Return to Home

Parent/Guardian Information

Parent/Guardian Last Name

Parent/Guardian First Name

Address

City

Email Address

Cell Number

Today's Date

State

Zip Code

Dancer's Information

Dancer's Full Name

School Name

Dancer's Date of Birth

Grade Level

List Allergies

What is your child’s diagnosis? Please be specific so we can prepare for their needs.

What items are addressed in their IEP or therapy plans that we can assist with or be aware of?

What would you like our teacher(s) to do to help your dancer:

Move in wheelchair/help with walking aids

Specialized care-please discuss with me personally

Other

Please check any of the following items that apply to your dancer:

Communication Section

Our teachers are dancers who want to share their love of dance with your dancer. These committed teachers provide: help with balance and standing, help with focusing and following directions, help with safety issues related to stability, verbal encouragement and praise along with warm caring hugs whenever appropriate. If care is needed beyond this level, we will meet
to see how we can work together to address needs.

Students must be able to exhibit basic communication skills (dancers can be non-verbal, just need to be able to communicate at a basic level). Students need to exhibit appropriate social behavior and general self-control that would be expected for their age with expected developmental disabilities. We are not trained special education experts and are not equipped to work with all students including severe discipline problems or children with difficult medical care. We will seek to provide dance education to as many children as possible. Your child’s safety is of the utmost importance to us. If for any reason, you have concerns regarding the safety/treatment of your child, please notify the Program Director and studio owner immediately.

Select "Yes" below to indicate you read, understood, and accept the information and requirements in the Communication Section of this form. Otherwise, select "No".

Yes

Dancer's Measurements

Shirt Size

Pant/short size

Pants waist number

Bust

Waist

Hips

Phot0/Video Release

I grant Darby's Dancers at Mountain Movers Creative Arts the right to publish, reproduce, and copy my dancer's edited and unedited, printed and digital still or motion image(s) as needed for the benefit of the Darby's Dancers Program. This includes, but is not limited to, using the still and motion image(s) for hardcopy (printed) and digital advertising and marketing. In addition, I waive the right to any compensation for using edited or unedited still or motion images and audio for hardcopy (printed) and digital advertising and marketing.

Select "Yes" below to indicate you read, understood, and agree to the terms and conditions stated in the Photo/Video Release Section of this form. Otherwise, select "No".

Yes

By submitting this form, I acknowledge that I am granting permission for the dancer shown on this application to participate in all aspects of the Darby’s Dancers Program at Mountain Movers Creative Arts.