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RegistrationForm2013 14

This registration form collects student information including name, address, date of birth, class schedule, and emergency contact details for three children. It also includes a liability waiver authorizing emergency medical care and releasing the dance studio from liability for any damages or injuries resulting from participation in their programs.

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ballaredancestudio
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412 views1 page

RegistrationForm2013 14

This registration form collects student information including name, address, date of birth, class schedule, and emergency contact details for three children. It also includes a liability waiver authorizing emergency medical care and releasing the dance studio from liability for any damages or injuries resulting from participation in their programs.

Uploaded by

ballaredancestudio
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Registration Form Student Information LAST NAME: ADDRESS: CITY:

CHILD'S NAME: CHILD'S NAME: CHILD'S NAME:

Date

STATE:
AGE: AGE: AGE: DATE of BIRTH: DATE of BIRTH: DATE of BIRTH:

ZIP CODE:
CLASS DAY & TIME CLASS DAY & TIME CLASS DAY & TIME

Mother's Name
HOME PHONE: CELL PHONE: EMAIL:

Father's Name

Alternate Contact Name

In case of serious emergency or illness when a parent cannot be reached immediately, I hereby authorize the teacher to obtain medical care from physicians, paramedics or other authorized emergency agents for my child and agree to pay for the said care. In consideration of my child's acceptance into Ballare Dance Studio program. I understand that my child's participation is entirely voluntary, further, that there is risk of accidental injury involved in these activities. I herby forever release Ballare Dance Studio, it's directors, staff, and all personnel connected with the conduct of Ballare Dance Studio from liability for any and all damages or injuries suffered by (my child) in connection with his/her participation in the program. I HAVE READ AND UNDERSTAND THE RISKS THAT ARE INVOLVED Signed: Date:

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