REGISTRATION FORM

Students Information

Last Name ___________________________________ First Name _______________________________

Birthday __________________Age ________ Grade ____________Allergies ______________________

Class/s Day, Time ____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Second Student Information

Last Name ___________________________________ First Name _______________________________

Birthday __________________Age _________Grade ____________Allergies ______________________

Class/s Day, Time  ______________________________________________________________________________________________________

____________________________________________________________________________________________________________

Home Information

Address ______________________________________________________________________________

Sub Division __________________________________________________________________________

City, State & Zip _______________________________________________________________________

Home Phone # _________________________________  Emergency Contact #______________________

Guardian Information

Mothers Full Name _______________________________________Mothers Mobile # ________________________

                                                                                                                    Text messages Yes______ No_______

Mothers E-mail address ___________________________________Do you read emails on a regular basis Yes _____No_____

Fathers Full Name ________________________________________Fathers Mobile # _________________________

                                                                                                                     Text messages Yes______ No_______

Fathers E-mail address ____________________________________Do you read emails on a regular basis Yes _____No _____

General Information

How did you hear about us?_______________________________________________________________

Students Previous Training – Where & how long ______________________________________________

Are you currently studying dance elsewhere? If so, where _______________________________________

Do you intend to study dance elsewhere? If so, where __________________________________________

Ø      Injuries:  Parents, legal guardians of minor students and adult students waive the right to any legal action for any injury sustained on school property or any other performance venue resulting from normal dance activity or any other activity conducted by the students before, during or after class or during performance time.

Ø      Photo Release:  The school is hereby granted permission to take photographs of the students to use in brochures, web sites, posters, advertisements and other promotional materials the school creates.  Permission is also hereby granted for the school to copyright such photographs in its name.  Approved Yes __________________ No________________

Signature of Guardian  _____________________________________________                                       Date ________________________________