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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 ________________________________

Mt. Pleasant Performing Arts Company      
Artistic Director Larisa Dahabi    *   Tel.  843-971-7880   *     Email - mpspa@comcast.net
Contact Person -  Anne Vesery
1510 Highway 17 North, Mt. Pleasant, SC 29464
 
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