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 NICK NAME:____________________________________________________________
BIRTH DATE: AGE
HOME PHONE: WORK PHONE:
PARENTS NAME: Dad: Email:
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)
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)