REGISTRATION FORM
The Afro Kuumba Dancers
Season: September 2021 - June 2022
Signup Date:
The AfroKuumba Dancers Check List
Primary Billing Phone # Legal Release and Policy Acceptance (please initial) I/we understand the Studio Policies I/we understand the risks related to dance I/we understand the dress code I/we give media use rights permission
I/we understand my billing obligations I/we understand my responsibilities for my property I/we understand the schedule I/we understand the attendance policy
Primary Phone: Name of Person responsible for paying tuition/ co. fees: Primary Email Address
Phone (2)
Mailing Address:
Date of Birth (MM/DD/YYYY):
Student's Name:
Season: September 2021 - June 2022 Signup Date:
Signup Date
/
Month
/
Day
Year
Date
Mailing Address
Student's Name
Primary Phone: Name of Person responsible for paying tuition/ co. fees: Primary Email Address
Format: (000) 000-0000.
Phone (2)
Format: (000) 000-0000.
Primary Email Address
example@example.com
Signature / Responsible Party
Primary Billing Phone # Legal Release and Policy Acceptance (please initial) I/we understand the Studio Policies I/we understand the risks related to dance I/we understand the dress code I/we give media use rights permission
Format: (000) 000-0000.
Date
/
Month
/
Day
Year
Date
Group
Registration Fee
September Tuition
Concert Fee
Costume Fee
Discounts
Comp Fees
Total Monthly Tuition
Measurements
Height
Shoe Size
Girth
Tights Size
Inseam
Leotard Size
Allergies: Will your child require any special medical attention during a normal class: (yes/no)
Allergies
Will your child require any special medical attention during a normal class: (yes/no)
If yes - Explain: Administration only: [] - Recorded
Paid in full
On hold Processed by:
If yes Explain
Processed by
Special Notes
Recorded
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