2024 Route 66 Dance Studio -Student Registration & Waiver

Student Name

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
Phone Number/Cell Number*
Please enter a number where you can get text messages from Rte 66 Studio. You agree to receive sms.
E MAIL*
example@example.com
Parent or emergency contact NAME*
CELL PHONE Emergency Contact*
Classes Attending*

Pre-ballet/tap (3-5yrs) Thurs. 4:15-5:00pmBallet/tap combo (5-8yrs) Wed 4:30Ballet I (7-14yrs) Wed 5:30pmAcro-Dance (6-14yr) Friday 4:30pmHip-Hop (9-17yrs) Friday 5:30pmJr. Hip Hop (4-8yrs) Thursday 5-5:45pm.Flamenco (Beg. Tues/Sat or Sun Adv.)Salsa (Beg)Level 1 Thursday 7:30pmSalsa level II (Int/adv) Thurs. 8:30pmBachata II Mon. 8:30pmBeg. Bachata I Mon. 7:30pmBeginning Bellydance Wed. 7:30pmBellydance II (choreography)Tues. 7:45pmAdult Ballet Wednesday 8:30pmPerformance Dance Team Friday 6:30pm
Release of Liability (photo, video & digital release).
It is understood that upon signing this agreement, I assume full responsibility for myself & or child for any injury or damage from any cause whatsoever resulting directly or indirectly from participation in the exercise, dance class, performance or program. I waive any claim against Yvette Garcia, Route 66 Dance Studio, its instructors and independent contractors, hereby making this a full release of all liability for personal injury, theft or loss of personal belongings or holdings.
Monthly Tuition is due on the first of each month, payments received after the second class will be charged a $5 late fee or classes will be charged at a higher drop in rate. Registration fee is non-refundable. Tuition is non refundable & non transferable. No make up classes. *Monthly rate is discounted, where single class price is higher.
I grant Yvette Garcia D.B.A. as Route 66 Dance Studio & its instructors permission to use & take photographs & video for any legal purpose including, but not limited to marketing/advertising, virtual classes, class videos, social media posts, studio or dance related web content. I understand that NO royalties, fees or compensation of any kind shall become payable to me by reason of such use. I acknowledge that I have read & fully understand the above release & policies.
Signature (Parent/guardian or student over 18)*

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Date*

MonthDayYear
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