Private Dance Lesson Request

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Name of Person Requesting Lesson


Age of Person Requesting Lesson


Home Phone


Cell Phone


Email Address


Emergency Contact Information

Emergency Contact Information

Relationship to Self


Preferred Day(s)/Time(s)


Special Considerations


Please choose the type of service you are requesting.

Please choose the type of service you are requesting.
Thank you for your request for private dance lessons. Please make note of the following:

 *All services are by appointment only 
 *There are no discounts on the cost of any services unless authorized by the Recreation Program Supervisor
 *Clients must pay for all services in advance
 *Sessions are approximately sixty minutes

 To cancel a session YOU MUST CONTACT YOUR INSTRUCTOR DIRECTLY WITH 24 HOURS of your scheduled session. Failure to cancel within 24 hours will result in you being charged for the session. Clients who arrive more than 15 minutes late will be charged for the session. In addition, the instructor may cancel the session. Participant assumption of risk: I understand that participation in any physical activity involves inherent risks, and than even when safety precautions are utilized, injuries can occur. I fully agree to assume all risk involved when following the instruction prescribed by Ida Lee Recreation Center and its staff. I am aware that personal health/accident insurance is my responsibility. I claim that to the best of my knowledge, I do not have any medical issue that will prohibit my safe participation. 
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