Passion for Dance Academy Sign-Up Form
Student Name
First Name
Last Name
Student Date of Birth
Student Gender
Female
Male
Signing Up for
Ballet
Modern
Contemporary
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
Student Email
Emergency Contact Person Name
First Name
Last Name
Emergency Contact Number
Emergency Contact Email
Any Medical Information - Allergies/Medical Conditions
I hereby waive any claim, which I may have against Passion for Dance Academy or any of its staff or management for any damages sustained by any person which may arise in connection with the tuition by aforementioned whether such damage arise as a result of theft, loss of life, bodily injury or any other cause whatsoever. This waiver is unconditional and is given both in my personal capacity as client/mother/father and/or natural or legal guardian of any minor concerned.
Please Select
Yes, agreed
Please take note of the following: - One month's, paid notice is required should you wish to terminate the contract
Please Select
Yes, agreed
Student Signature
Date Completed
-
Month
-
Day
Year
Continue
Continue
Should be Empty: