Michele Compa Fall 2022 Registration Form

Fall 2022 Registration Form

This form is for adult dance and exercise students and parents of students 18 years of age or younger, interested in taking dance classes. **PLEASE NOTE: This does not complete your registration** To ensure your spot in the class and complete registration, you will be contacted by Michele Compa via e-mail on how you would like to proceed. If you do not hear from us, please contact Michele Compa at compamichele@yahoo.com or call us at &718)-549-9635. We look forward to dancing with you this year!
Parent or Student's Name *

First Name Last Name
Child's Name *

First Name Last Name
Child’s Age *
Child's Birthdate *

Month Day Year
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Desired Classes (select all that apply): *
Parent/Family Email: *
example@example.com
Cell Phone: *
Please enter a valid phone number.
Home Phone:
Please enter a valid phone number.
Alternate Phone:
Please enter a valid phone number.
Warranty of Fitness and Agreement to Limitation of Liability: I hereby certify that I am physically capable of participating in this exercise program designed by Michele Compa Dance and Exercise Center. I have no physical disability, impairment, or ailment that would prevent me from engaging in such active or passive dance exercise programs; nor do I have any physical conditions which should detrimentally aggravate. Furthermore, I agree that I shall participate in classes and use the facilities entirely at my own risk and agree not to hold Michele Compa or any of her employees liable for any injury or damage which may occur to me in the above said class. I also understand that classes paid for must be taken within the session period. Class monies may not be credited toward future sessions. There are no refunds without an authorized medical excuse. *

Parent Signature Clear
Should be Empty: