Kids Night Out Registration Form

Kids Night Out Registration Form
Dancer’s Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
Age*
Phone Number*

Area CodePhone Number
Email (this is the email we send all communication through, you can add multiple emails)*
Years of Dance Experience*
Any Medical Conditions, Allergies or Special Needs that we should be aware of*
How did you hear of us? (If not a current dancer already)
Parent or Guardian Information (If Applicable):
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact (If Different than Parent or Guardian Information)
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Dancers must be able to use the bathroom alone to attend.

Payments can be made by cash or checks, make checks payable to Contemporary Academy of Dance. Payments are non-refundable.
All Tuition information and Policies are listed on our website.

For public relation purposes photos and videos may be taken of you or your child. If you object to the use of these photos or videos you must notify Contemporary Academy of Dance in writing.
Liability Release
Contemporary Academy of Dance is not liable for any injury, damage or loss of property. I release Contemporary Academy of Dance from all liability, injury, damage or loss of property. I have read and agree to the payment terms, fees, and policies listed on our website.
Signature*

Clear
Date*

MonthDayYear
Date
Once this form is submitted, you will receive an email confirmation within 48 hours. Please check your junk mail if you did not receive an email confirmation.
Should be Empty:

Kids Night Out Registration Form

Parent or Guardian Information (If Applicable):

Emergency Contact (If Different than Parent or Guardian Information)

Liability Release