Downtown Dance Company Registration Form

ONE STUDENT PER FORM PLEASE

 

 

 

Student's Name__________________________________Age________ Date of Birth______________

 

Home Phone __________________School___________________________Grade__________

 

Address_________________________________________City____________________Zip_________

 

Parents- Dad ____________________Cell_________________Email___________________________

 

Mom_____________________Cell_________________Email__________________________

 

EMAIL ADDRESS(s) Confirmation will be sent via email

 

_________________________________________________________________________________

 

Person responsible for payment (if other then parent) ____________________________________

 

 

 

DOWNTOWN DANCE COMPANY CLASSES:

 

½ hr Little Movers (ages 2-4): ______ 1hr Tap/Ballet (grades K-2): _______

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1hr Jazz/Tap (9yrs old & up or based on ability): ______

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1hr Ballet (9yrs old & up or based on ability): ______

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1/2hr Hip Hop (6yrs old & up or based on ability): ______

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1hr Musical Theater (ages 6 & up): _______

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1hr Jazz (12yrs old & up or based on ability): ______

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½ hr Tap (12yrs old & up or based on ability) ______

 

½ hr Hip Hop (12yrs old & up or based on ability) _______

 

1hr Ballet (12yrs old & up or based on ability) _______

 

Competition Team 1hr Class (Must be 10 yrs old to join): ______

 

 

 

 

 

 

 

 

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MEDICAL AUTHORIZATION, RISK NOTIFICATIOIN, LIABILITY WAIVER

 

Emergency Contact(non-parent)______________________Relationship to student________________

 

Home Phone_______________________Work Phone__________________Cell__________________

 

Family Physician__________________________________________Phone______________________

 

Clinic Address____________________________________________________

 

Medical/Physical limitation? (ex: asthma)_______________________________________________

 

Medications____________________________________________________________________

 

Allergies to medications or otherwise____________________________________________________

 

In case of illness or injury and a parent cannot be reached, the staff of Downtown Dance Company, may authorize medical treatment for the above named student. I understand that because of dance involves motion, there is a risk of injury. I and my heirs hereby release Downtown Dance company, it employees, instructors, managing members and owners from liability for damages and/or injury or medical expenses which might occur as a result of my child's participation. My child has no problems that might compromise his/her safe involvement.

I understand that Downtown Dance Company reserves all the rights to the dance choreography taught in classes. Downtown Dance Company reserves the right to dismiss any student/family for failure to follow the studio rules and policies. All registration fees, tuition, costumes fees and recital fees are non-refundable.

I (we) have read, understand and agree with all the rules and policies on payments and billing fees set by Downtown Dance Company.

 

 

Parent Signature: _______________________________________________ Date:______________

 

May we use dance photographs/video clips containing you or your child for promotional purposes? This may include, but is not limited to, material on our website www.downtowndanceco.wix.com/downtowndanceco

_______Yes ________No

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY: DATE RECEIVED ___/___ENTERED BY:______CONFIRMATION SENT _______