Registration Form

Student's Name*

DOB*

Preferred Name

Guardian's Name*

Relationship*

Address*

City*

State*

Zip Code*

Phone*

Second Phone

Email*

How did you hear about Dance Institute?

List any medical conditions of student

Additional Emergency Contact

Relationship

Phone

Class(es) Registering for (List class title, date, time)

Release and Liability Waiver

I understand and agree Dance Institute LLC, and its representatives are not responsible for any injuries or illness that may occur as a result of participation in class, student activities or performances. I hereby waive and release all claims, liabilities, actions, damages, costs or expenses of any nature whatsoever for injuries the student might sustain while participating in any and all activities.

A $15 registration fee and first tuition payment is due at time of registration. I have read and agree to accept the policies of Dance Institute LLC. I fully understand accept the Liability Waiver.