Contact Us!
This form does not yet contain any fields.

    2018-2019 Registration Form

    (PDF)

    Please fill out registration form and mail it to the studio to enroll.  Tuition is due at the time of enrollment.

    Linda Larma and Daughters Academe of Dance
    12748 Jomani Dr.
    Bakersfield, CA  93312
    661-589-8208
    661-589-7564 fax

    Name of Student_______________________________________________________________________  

    Girl  /  Boy  (please indicate)


    Age__________Birthdate________________HomePhone___________________

     

    E-Mail__________________________________________


    Billing Address____________________________________________________________________________________________________

     

    City__________________________________Zip__________________________


    Mother*s Name____________________________________________________________________________________________________


    Employer_________________________________________________________

     

    Work Phone_____________________________________


    Father*s Name_____________________________________________________________________________________________________


    Employer__________________________________________________________

     

    Work Phone_____________________________________

    Emergency Contact-(other than Parent)

     

    Name_______________________________________________Phone_________________________

    I am aware that during the dance activities 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 activities that may result in various injuries.  In recognition of these risks, I hereby agree not to hold Linda Larma & Daughters Academe of Dance, Linda Larma, Her Teachers or Employees liable for any injuries that may occur during participation of said activities.  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 & Daughters Academe of Dance.


    Parent or GuardiansSignature___________________________________________________________Date__________________________

     

     

    Class Day__________________Time__________

    Have you ever been in dance before?  Yes -  No   How Long_____