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Dance
2023 Fall Dance Registration
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Date
*
Child Information
Name
*
First
Last
Age of Child
*
3 - 4
5 - 7
Date of Birth
*
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Parent/Guardian Information
Name
*
First
Last
Email
*
Phone
*
List Allergies / Medical Concerns
*
Liability Release - Type Name in box after reading
*
I hereby consent to have my child participate in dance classes offered by The Studio. The risks involved in respect to such a program are fully understood. It is hereby agreed that I, my child/adopted or otherwise, my executors, waive and release all rights and claims for damages that I or my child may have at any time against The Studio and their representatives whether paid or volunteer, for any sickness, injury, permanent disability, or death in connection with all of The Studio’s classes, or other activities related to The Studio. I certify that I have medical insurance on my child that will provide coverage while enrolled. I further give permission for photos, videos and/or audio of my child to be used in print, social or broadcast media as deemed appropriate for the promotion of The Studio.
Check Box To Agree to Liability Release
*
I have read Liability Release & Agree
Submit