Academy of WDA Registration Form OLD

Academy of WDA Registration Form
Please fill out this form and your information will be sent to our office. Thank You!
Student Full Name:
Age:
Birthdate:

MonthDayYear
School:
Grade:
Student 2 Full Name:
Student 2 Age:
Student 2 Birthdate:

MonthDayYear
Student 2 School:
Student 2 Grade:
Contact Information
Home Phone:
Parent 1 Full Name:
Parent 1 Cell Phone:
Parent 2 Full Name:
Parent 2 Cell Phone:
Primary Email Address:
Home Address:
City:
Zip code:
Emergency Contact Information
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relation:
Any important medical concerns that we should know about?
Insurance Company Name:
Policy Number:
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Academy of World Dance n Arts Registration Form
Classes
Previous Dance Experience?:
Classes you are interested in:
For what day and time would you like to schedule you first class?
How did you hear about us?
Referred by- WDA Dancer's Name:
Click to View World Dance n Arts Studio Policies (Opens in a new window)
Release from Liability and Indemnification: I understand and agree that by signing this waiver, I am freeing "Academy of World Dance n Arts" and it’s employees, officers, or agents from any liability resulting from my (or my child’s) participation in this sponsored event, activity, or class. I recognize that participation in these sponsored events, activities, or classes can be dangerous to me (or my child), and accept those dangers. I understand that if I am (or my child is) injured, this waiver can be used against me and anyone else claiming any damages in legal action. I also understand that photos and videos may be taken throughout the year and these images may be published or used for advertising and promotional purposes by Academy of World Dance n Arts, and its agents.
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Academy of WDA Registration Form