Student Registration Form

STUDENT INFO
Student #1 First Name*
Student #1 Last Name*
Student #1 Date of Birth*
M-D-Y
Student #1 Age as of August 1st*
Student #1*

FemaleMale
Student #1 Medical Conditions or Allergies*
Student #1 Academic School
Student #1 Grade
Student #1 T-Shirt Size
Student #1 Classes Interested In

Creative MovementPre-ComboTapBalletContemporary (ballet required)Acrobatic ArtsJazzPomHip Hop
Student #2 First Name
Student #2 Last Name
Student #2 Date of Birth

MonthDayYear
M-D-Y
Student #2 Age as of Aug 1st
Student #2Medical Conditions or Allergies
Student #2

FemaleMale
Student #2 Academic School
Student #2 Grade
Student #2 T-Shirt Size
Student #2 Classes Interested In

Creative MovementPre-ComboTapBalletContemporary (ballet required)Acrobatic ArtsJazzPomHip Hop
CONTACT INFO
Parents Names*
Address*
City*
Zip Code*
Home Phone #
Cell Phone #*
Work Phone #
Second Cell #
EMail Address*
example@example.com
Emergency Contact 1 - other than parent*
Full Name
EC1 - Phone #*
Format: (000) 000-0000.
EC1 - Relationship to Student*
Emergency Contact 2 - other than parent*
Full Name
EC2 - Phone #*
Format: (000) 000-0000.
EC2 - Relationship to Student*
BILLING
Person Responsible for Account Payments*
Street Address if different from above
City
Zip Code
Phone #
Format: (000) 000-0000.
WAIVERS
Liability Release By registering, all parents and/or guardians agree to hold harmless from all liability No Limits Dance Studio, Inc., its officers, employees, and contractors both in their professional capacity and personally for all injury or illness resulting from or in any way connected with his/her participation in the classes, activities or spe- cial events at the studio. No Limits Dance Studio, Inc. assumes no responsibility for lost, misplaced, or stolen articles. Please put your name in all your belongings and do not leave valuables unattended.
Liability Release - Signature of Parent*
Medical Emergency Policy I grant permission to the staff of No Limits Dance Studio, Inc. to take first aid or emergency measures as judged necessary for the care and protection of my child while under the supervision of the studio. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the emergency unit deems it necessary. I understand that in some medical situations the staff will need to contact the emergency resource before the child's parent, physician, and or other person acting on the parent's behalf. I also understand and agree that the child's parents or legal guardians shall be responsible for any expenses incurred.
Medical Emergency Policy - Signature of Parent*
June Tuition Special note regarding June tuition: Enrollment is based on an 11-month schedule, August - June (regard- less of the number of classes attended per month June tuition is for the full amount even though the recital is generally the first Friday or Saturday. This is because your dancer will still be receiving the full value of their instruction-just in a different format. The time and dedication given to any extra rehearsals (if sched- uled), the tech and dress rehearsal, and the recital day itself all replace standard weekly classes for the re- mainder of the month. Tuition for June is for the full amount.
June Tuition - Signature of Parent*
Signature of Parent Photo/Video Waiver I grant permission for No Limits Dance Studio, Inc. and staff to post any dance related pictures or videos of my child on social media.
Photo/Video Waiver - Signature of Parent*
Signature of Parent Costume/Tuition Payments I understand that costume payments will be broken up into payments beginning in September and will be charged to my account. I agree to make the monthly costume payments along with the tuition. I also un- derstand that if the amount due for tuition/costumes is past due 45 days then my child will not be allowed to participate in class.
Costume/Tuition Payments - Signature of Parent*
Should be Empty:

STUDENT INFO

CONTACT INFO

BILLING

WAIVERS