Heavenly Grace Dance Studio Registration Spring 2025

Dancer Information

Dancer's Name

First NameLast Name

Birth Date

MonthDayYear

Age

Preferred Class Enrolment (Not guaranteed)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the dancer have any allergies, chronic illness, or medical conditions? If yes, please describe.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation at Heavenly Grace Dance Studio. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Heavenly Grace Dance Studio from any and all liability for injuries to said child arising out of taking this class. In case of injury to said child, I hereby waive all claims against Heavenly Grace Dance Studio . While we do our best to insure safety, there is a risk of being injured that is inherent in all sports activities, including dance.

I give permission to Heavenly Grace Dance Studio to use photos of my child taking classes and during recitals.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Heavenly Grace Dance Registration Spring 2025