registration

$25.00 per dancer due now upon registration

Registration fee

Dancer's Name

First Name

Last Name

Date of Birth

YYYY

Checkbox

Preschool

Kindergarten/1st Grade

2nd/3rd Grade

4th/5th/6th Grade

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Mother

If not applicable, type n/a

Mother's Cell Number

(###)

###

####

Father

If not applicable, type n/a

Father's Cell Number

(###)

###

####

In case of emergency and parent's cannot be reached:

Name:

Phone:

(###)

###

####

Relationship:

Medical Information/Release

If my dancer should need immediate care and/or treatment as a result of any injury or sickness, I hereby request, authorize, and consent to such care and/or treatment as may be given by any physician, EMT, Paramedic, First Responder, or other EMS personnel.

Allergies/Reactions to Medications:

Medical Conditions (physical/emotional):

Parent/Guardian Initial

By initialing and dating below, I acknowledge my understanding of the medical information release.

Date

YYYY

Release Waver

I, parent/guardian of dancer, hereby give approval for participation in Dena’s Dance Company program and events. I assume all risks and hazards incidental to such participation including transportation to and from all activities; and do hereby waive, release, absolve, indemnify and agree to hold harmless Dena’s Dance Company, its Directors, Instructors, Organizers, Sponsors, Supervisors, Participants or Owners.

Parent/Guardian Initial

By initialing and dating below, I acknowledge my understanding of the release waiver information.

Date

YYYY

Photo Release

I hereby grant permission to Dena’s Dance Company to use photographs and/or video taken of my dancer in publications, news releases, online, and in other communications related to the mission of Dena’s Dance Company. I understand that there will be no compensation for the use of these photographs and/or video.

Parent/Guardian Initial

By initialing and dating below, I acknowledge my understanding of the photo release information.

Date

YYYY

Class Tuition Agreement

I am aware of tuition fees and policies, and understand that regular season class fees are due on or before the first Thursday of each Month. Registration fee of $25.00 should be paid at time of registration. I also understand that if my tuition is not paid by the due date, my dancer will be asked to sit out of class and will not be able to participate in any Dena’s Dance Company classes, events, or performances. I understand that it is my responsibility to obtain the class tuition amount due for my child(ren’s) class(es). I understand that a $10.00 per week late fee will be added to my payment every week until the tuition is paid. When there is NO SCHOOL, there will be NO dance classes unless stipulated on monthly calendars. In case of inclement weather the director will cancel classes at their discretion and a make up class may or may not be planned. I understand that if my dancer(s) is/are unable to complete the entire season, I am responsible to complete tuition and pay all fees that are outstanding. Dena's Dance Company expects that when a dancer registers for the season, all reasonable effort will be made by the dancer/family to complete the entire season.

Parent/Guardian Initial

By initialing and dating below, I acknowledge my understanding of the class tuition agreement information.

Date

YYYY