2025 Route 66 Dance Studio -Student Registration & Waiver

Student “Dancer” Name

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
Phone Number/Cell Number*
Please enter a number where you can get text messages from Rte 66 Studio. You agree to receive sms.
E MAIL*
example@example.com
Parent or emergency contact NAME*
Classes Attending*

Tiny Tot Dance (2-4yrs) Tues. 10:30-11amPre-ballet/tap (4-6yrs) Wed 4:30-5:30pmBallet I (7-14yrs) Wed 5:30pmAcro-Turns/Leaps (6-14yr) Wed 6:30pmJr. Hip Hop (4-7yrs) Thurs. 4:30pmHip-Hop (8-13yrs) Thurs. 5:30pmFlamenco (Beg. Tues/Sat or Sun Adv.)Salsa (Beg)Level 1 Thursday 7:30pmBeginning Bellydance Wed. 7:30pmBellydance II (choreography)Tues. 7:45pmAdult Ballet Wed 8:30pmTeen Dance Technique Mon. 5pmTeen Choreography Mon. 6pm
Release of Liability (photo, video & digital release).
It is understood that upon signing this agreement, I assume full responsibility for myself & or child for any injury or damage from any cause whatsoever resulting directly or indirectly from participation in the exercise, dance class, performance or program. I waive any claim against Yvette Garcia, Route 66 Dance Studio, its instructors and independent contractors, hereby making this a full release of all liability for personal injury, theft or loss of personal belongings or holdings.
Monthly Tuition is due on the first of each month, payments received after the second class will be charged a $5 late fee or classes will be charged at a higher drop in rate. Registration fee is non-refundable. Tuition is non refundable & non transferable. No make up classes. *Monthly rate is discounted, where single class price is higher.
I grant Yvette Garcia, Route 66 Dance Studio & its instructors permission to use & take photographs & video for any legal purpose including, but not limited to marketing/advertising, virtual classes, social media posts, studio or dance related web content. I understand that NO royalties, fees or compensation of any kind shall become payable to me by reason of such use. I acknowledge that I have read & fully understand the above release & policies.
My Products
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End of Season Registration Fee 20252025 Oct-Dec Annual Registration Fee (Only 1 per family) $10 + $2 online payment service fee. Registration Fee is for Children’s classes only.
$12.00 Quantity



Adult class Registration or 2nd dancer sibling of 1st registered dancer.Only for 18yrs plus or on the second dancer in a family (we only need 1 registration fee per family).
$ Free Quantity



Trial class only Valid only for children’s trial class. Registration and tuition collected at the studio once you sign up. $10 Trial plus $2 online payment fee
$12.00



Pay in studio on 1st DayWill pay registration, trial or tuition on 1st day. No credit or debit card accepted.
$ Free Quantity



Total

$0.00
Signature (Parent/guardian or student over 18)*

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Date*

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