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2007-2008

CLASSES ARE FILLING UP FAST!!   Please print this form and bring or mail to DEBBIE'S DANCE COMPANY as soon as possible.  There is a non-refundable fee of $30.00 per person to hold your spot in the class of your choice.  Classes are first come-first served until full.

STUDENT NAME:                                                                                                                      

STUDENT NICK NAME:____________________________________________________________

BIRTH DATE:                                AGE             

ADDRESS:                                                                                           

CITY                                  ZIP                   

HOME PHONE:                                    WORK PHONE:                                                

PARENTS NAME:  Dad:                                      Email:                                            

                                        cell:                                    work:                                      

                             Mom:                                   Email:                                              

                                      cell:                                     work:                                      

PLEASE CIRCLE THE CLASS/CLASSES

TAP             JAZZ             BALLET            POINTE      MODERN  

CHEERLEADING      BATON       ACROBATICS            LYRICAL   

FLEXIBILITY    HIP-HOP    PRE-SCHOOL COMBINATION 

I would like to AUDITION for the competition teams:         YES     NO

MONTHLY FEES FOR THE 2007/2008 SEASON ARE AS FOLLOWS:

$48.00 Month for your first one-hour dance class    

$27.00 for each one-hour dance class thereafter (For example:  2 one-hour classes =$75/month)

$15.00 each additional 1/2 hour of dance class (For example:  1-1/2 hour class = $63.00/month)

$7.00 month for each additional 1/4 hour of dance class (For example:  1 1/4 hour class = $55/month)

Discounts:  $10.00/month for the second and subsequent child in the same family enrolled at Debbie's Dance Company.

PHYSICIANS NAME :                                                                                                                                                      

EMERGENCY CONTACT IF WE CANNOT REACH YOU:

NAME:                                                                                                         PHONE (H)                                   (CELL)                          

RELATIONSHIP:                                                                                                      

 

RELEASE WAIVER AND ASSUMPTION OF RISK:

I hereby waive any and all rights for damages  that I or my child may have against DEBBIE'S DANCE COMPANY or it's employees, or for  injuries that I or my child may sustain while participating in any class or on studio property.  I further attest that I or my child are in good health, and are physically fit for the activity of dance or aerobics.  By signing below, I acknowledge that  I have read and understand this Release Waiver and Assumption of Risk form.

Signature of Participant (Parent/Guardian if under age 18)

                                                                                                         Date: