| Student First Name:
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Student Last Name:
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| Address: |
| City: |
State:
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Zip Code: |
| Telephone #:
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Cell #:
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| Email Address:
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| Confirm Email: |
Name: Parent/Guardian #1
Name: Parent/Guardian #2
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| *You must choose at least 1 Leaps, Turns and Conditioning Class and 1 Ballet Class |
| Required Leaps and Turns Choice:
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| Required Ballet Choice:
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| Class Choice 3:
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| Class Choice 4:
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| Class Choice 5:
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| Class Choice 6:
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| Class Choice 7:
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| Class Choice 8:
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| Class Choice 9:
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| Class Choice 10:
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| Class Choice 11:
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| Class Choice 12:
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| In case of emergency, please notify: |
| Emergency telephone: |
| Student's age as of 9/1):
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Birth Date: |
Please list past experience in dance (include styles of dance and number of years)
Name of previous danceschool:
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Any health or physical restrictions?
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How did you hear about our school?
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From time to time we take pictures during activities. We would like your
permission to use these pictures on our website, in our newsletter, or on our bulletin board. We
will never reference your child by name or provide any specific information regarding your
child. We also will never sell these pictures; we will use them exclusively for Denises Dance Academy's purposes.
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I understand that Denises Dance Company (DDA) and its principles, employees, and volunteers are not liable for any injuries
that may occur while my student is involved with participating in DDA related events, and hereby
release, indemnify and agree to hold harmless DDA and its principles, employees and volunteers
from any claims or expenses resulting from or arising out of the participation of my student in any such
activities or events. DDA is not responsible, whatsoever, for anything that happens before or
after the students designated class time. I do hereby verify that I have read and accept the Holds
Harmless Agreement, policies, and conditions shown by my signature below.
Do you agree by the terms and conditions above? |
