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    PDF Registration form


    2017-2018 registration form


    Name of Student_________________________________________________


    Age_________ Birthdate________ Home Phone________________________




    Billing Address__________________________________________________



    City__________________________________ Zip Code_________________


    Mother's Name_________________________________________________


    Employer__________________________Work Phone___________________


    Father's Name__________________________________________________


    Employer___________________________ Work Phone_________________


    Emergency Contact_______________________________________________

    (other than parent)

    I am aware that during the dance activites that my child participates in, certain risks may occur, including , but not limited to, falling or slipping to the floor, running into other participants and activites that may result in various injuries.  In recognition of these risks, I hereby agree not to hold Linda Larma and Daughters Academe of Dance, Linda Larma, Her Teachers, or Employees liable for any injuries that may occur during participation of said activies.  I hereby give my consent of my son/ daughter to participate in the above activity.  I hereby stated that minor is physically able to participate.


    I have read and agree to the policies of Linda Larma and Daughters Academe of Dance.


    Parent or Guardian Signature___________________________ Date___________


    Class Day_____________ Time____________ Location(circle) Studio or Daycare


    Have you ever been in dance before? Yes/ No                            

    How Long______________