Registration Form
Dancer Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Name:
First Name
Last Name
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
-
Area Code
Phone Number
Cell Phone:
-
Area Code
Phone Number
Parent Email
*
example@example.com
Person responsible for account:
First Name
Last Name
Additional Parent/Guardian Information:
Emergency Contact Information:
*
Full Name
Relationship
Emergency Contact Number
*
-
Area Code
Phone Number
Any medical concerns or allergies of which we should be aware?
If yes, please explain
Will your child require any special medical attention during class?
If yes, please explain
Legal Release and Policy Acceptance (please check each statement)
*
I/We understand the Studio Policies
I/We understand the risks related to dance
I/We understand my billing obligations
I/We understand the Dress Code
I/We understand the attendance policy
I/We understand my responsibilities for my property
I/We understand the Schedule
I/We give media use rights permission
I agree that all information is correct and up to date, and I understand and accept all policies.
*
Parent Signature
Submit
Should be Empty: