Annual Show Costume Order Form

*Costume Size:

Choose the costume size your child needs. If he/she is between sizes, choose the larger size (remember they will grow before the show!).

*Child's First Name:

First name of child for whom you are ordering the costume

*Child's Last Name:

Last name of child for whom you are ordering the costume

*Child's Date Of
Birth:

/ /

*Child's Gender:

Boy
Girl

*Parent First Name:

First name of primary parent or guardian

*Parent Last Name:

Last name of primary parent or guardian

*Street Address:

Please use the same address you have on file with us at Dancercise

*City:

*State:

*Zip:

*E-Mail Address:

Please use the same e-mail address you provided to Dancercise Kids

Additional Comments:

(chars left: 240)

Enter anything else we need to know (for example, if you have any concerns about the costume or size)

*Payment Method:

Charge My Card On File
Contact Me For A Different Card
I Need A Payment Plan

By default we will charge the card you use to settle your monthly charges with Dancercise Kids. Show time and details will be mailed to your home mid-May with your costume.

*Terms And Conditions:

By checking this box, I am acknowledging that I realize that Kids Fun Inc. offers a comprehensive program of activities for children including various forms of exercise, dancing and tumbling that can result in physical injury. While the Dancercise® Kids instructors make every effort to ensure the children’s safety, I will not hold Kids Fun Inc., its employees or any of its subsidiaries or affiliates liable in the highly unlikely event that my child or I should sustain an injury. I agree to allow Kids Fun Inc. to use my likeness and that of my child in photographs and/or video solely for advertising and promotional purposes without compensation to my child or myself.

*Image Verification:

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