Register Online
Student #1 Name: * Birthdate: Age: Current grade:
Student #2 Name: Birthdate: Age: Current grade:
Student #3 Name: Birthdate: Age: Current grade:
Home Address: * City: State: Zip:
Home telephone: *
Parent's/Guardian's name: Cell:
Email address: *
Academic School(s) Attending:
Any health concerns, ongoing injuries, or food allergies?
How did you hear about us?
Emergency Information (If we can't reach parents)
Emergency name:
Telephone: Relationship to student:
* = required items
Previous Dance Experience:
Student 1: Years of Training: Subjects Studied:
Student 2: Years of Training: Subjects Studied:
Student 3: Years of Training: Subjects Studied:
Please see our Classes & Schedule page for class offerings, days & times. Placement will be determined by Teacher Discretion.
Tuition is due by the 1st week of each month. If tuition is paid after the 10th of the month, a $5.00 late fee will be assessed, $10.00 after the 20th of the month. I understand that tuition is based on a breakdown of 9 monthly payments, we do not prorate for missed days, holidays or inclement weather cancellations. Please review our studio Rules & regulations packet.
I, the below undersigned, do hereby release DANCERS ONLY, LLC, its owner, faculty, and staff from any and all claims for damages or for injuries which may be sustained while participating in any class or event connected with DANCERS ONLY, LLC. I understand that DANCERS ONLY, LLC is in no way responsible for any injuries or damages sustained in or around the dance facility.
By checking this box, I indicate that I have read and understand the liability/policy statement above.
Parent/Legal Guardian name: * Date:
