Dance Classes Registration

Dance Classes Registration Form

Details of Dancer
Dance Mouse (RRR-R)Dance Madness (Gr. 1-7)DMC Ballet (RRR-R)DMC Ballet - (Gr. 1-7)Dance Mouse & DMC Ballet Combo RRR-RDance Madness & DMC Ballet Combo Gr.1 - Gr.6
Date Started

MonthDayYear
Date
Dancers Name*

First NameLast Name
BoyGirl
Date of birth*

MonthDayYear
Date
Age
School*
Grade & Class *

GradeClass
Medical Conditions or Allergies*
Parent/Guardian 1 Responsible for the Account *

First NameLast Name
Parent 1 ID Number*
Parent 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email 1*
example@example.com
Name of employer*
Parent/Guardian Name 2 *

First NameLast Name
Parent 2 ID Number*
Parent 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent 2 Email*
example@example.com
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Relative Not Living With You*

First NameLast Name
Relationship to Student
Relative Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YESNO
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Terms and Conditions:

By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release DANCE MOUSE COMPANY and its instructors from any liability for injuries or accidents that may occur during classes or events.

I understand that the cancelation of my child's classes is subject to a one month written notice.

I understand that should a child be unable to attend a lesson for whatsoever reason e.g. absence / school events, the lesson will be forfeited.

There will be no lessons on Public Holidays.

I undertake to pay my fees in advance before the 7th of each month and understand that my child will receive no lessons until such payment has been made.

I undertake to pay my fees in full each month of enrollment until and including the month of November.
Date signed

MonthDayYear
Date
Type a question
Should be Empty:

Dance Classes Registration Form