Foundations in Dance (Students 5-8 years old) Registration Form

Lyrical/Jazz Dance Registration Form

4-Week Sessions
Family Contact Information
Father/Guardian Name

First NameLast Name
Mother/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Second Cell/Home Phone

Area CodePhone Number
Emergency Contact (Not Parent)

First NameLast Name
Emergency Contact Relation to Student(s)
Emergency Contact Phone

Area CodePhone Number
Parent Email
example@example.com

Student(s) Information
Student 1
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Special Medical or Health Factors
Please select the class(es) you would like to register Student 1:

Pre-Teen Lyrical Dance (ages 8-11 years old) begins in JanuaryTeen Lyrical Dance (ages 12-18 years old) begins in JanuaryPre-Teen Beginning Jazz Dance (ages 8-11 years old) begins in FebruaryTeen Beginning Jazz Dance (ages 12-18 years old) begins in February
Student 2

Please continue to bottom of page if not applicable.
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Special Medical or Health Factors
Please select the class(es) you would like to register Student 2:

Pre-Teen Lyrical Dance (ages 8-11 years old) begins in JanuaryTeen Lyrical Dance (ages 12-18 years old) begins in JanuaryPre-Teen Beginning Jazz Dance (ages 8-11 years old) begins in FebruaryTeen Beginning Jazz Dance (ages 12-18 years old) begins in February

Waiver
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen by nature of the physical, athletic activity engaged in while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage.

I understand that the art of dance and nature of dance instruction may sometimes require a teacher to touch my child(ren). I also understand that this will happen in a respectful, gentle and appropriate manner. I understand, further, that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc.

I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time.

I agree to pay the $30 tuition fee per student. I will remit payment no later than the first class. I understand that tuition is non-refundable.

By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.
Please check the box below to signify that you have read and agreed to the above statement.*

I agree

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Lyrical/Jazz Dance Registration Form

Family Contact Information

Student(s) Information

Waiver