Drop in Dance Class Registration Form
Scarborough Music Theatre Youth
Student Information
Name
*
First Name
Last Name
Age
*
Name of Emergency Contact and phone number
-
Name/Relationship
Phone Number
Email
*
example@example.com
Parent/Guardian Information
For minors (below 18 years of age)
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Payment & Confirmation
Payment Method
*
Cash $20 - 19+
Cash $15 - Under 19
I understand that if I do not bring exact change, facilitator may not have change to give.
*
Yes, I understand
Date Signed
*
-
Month
-
Day
Year
Date
Insurance
The insurance policies of Scarborough Music Theatre DO NOT COVER any of your personal items, regardless of whether or not the items are being used during a dance class.
*
I agree that Scarborough Music Theatre will not be held responsible for any personal items that may be damaged, lost, or stolen, no matter how such damage, loss or theft may occur.
Release of Personal information waiver
*
I agree to allow Scarborough Music Theatre to use my image (photo or video) and/or non-biographical information to promote SMT programming. (Eg. social media)
I do not agree
Other
How do you learn about this online dance class?
Facebook
Instagram
Referral
Other
Signature of Participant/or Guardian
First Name
*
Last Name
*
Date
*
-
Month
-
Day
Year
Date of class (please see flyer)
For any further questions please email Aliyah at Aliyahjaclynnh@gmail.com
Submit
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