Summer classes registration form
Teknique School of Dance
Students Name
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First Name
Last Name
Students birth date
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Month
-
Day
Year
Date
Students age by December 31, 2025
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Primary Parent or Gurdian
*
First Name
Last Name
Primary contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary contact is Email
*
example@example.com
Secondary parent or guardian/emergency contact
*
First Name
Last Name
Secondary/ Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Classes
Pick your time based on age
Summer classes Tuesday July 7,14,21,Aug 4,11,18 6 weeks
5:30-6:30 try it all (ages 6-9)
6:30-7:30 try it all (ages 10-13)
In consideration of my child and myself being registered at Teknique School of Dance, I undersigned release, waive and forever discharge Teknique School of Dance and all of the respective employees, volunteers and the principal against all claims or demands whatsoever for any injury, loss or damage sustained by the child and or myself, however caused, arising out of or in connection to Teknique School of Dance.I have received a copy of Teknique School of Dance’s policies, which express refund policies, and dress code, and I agree that we shall abide by the rules set forth. By signing and submitting this form, and on behalf of my son/daughter and or myself, I acknowledge having read and agreed to the above released
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MEDIA RELEASE FORM FOR ONLINE PURPOSES: I, the undersigned, herby grant permission to the Teknique School of Dance to photograph, and or record my son/daughter/myself on video or tape, and use this material in whole or in part, to promote the Teknique School of Dance, through media, film, internet, or in printed form. I understand that the visual material and the copyright therein will remain the sole property of Teknique School of Dance. I further waive any claim to remuneration for use of this visual material used for there purposes.
I understand that the recital is recorded for distribution to all families who have registered at Teknique School of Dance. Should I not want my child recorded for this purpose I will withdraw my child from dancing at the recital.
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Were you referred by anybody?
Any other information we should know? Eg. Allergies, medical conditions, injuries, disabilities etc…
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