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    PDF Registration form

     

    2017-2018 registration form

     

    Name of Student_________________________________________________

     

    Age_________ Birthdate________ Home Phone________________________

     

    Email__________________________________________________________

     

    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______________