Born To Dance
Registration Form

Father's Name_____________Mother's Name___________________

Street Address_________________________________________________

City____________________Zip___________HM#_______________


WR#________________________Cell#_______________________


E-Mail_______________________________________


Student Name___________________________________________


Age____________________Birthdate_________________________


Grade in school as of coming September_______________________

Additional Info (such as health problems)

______________________________________________________

I understand that Born To Dance Studio is a certified and conscientious organization and that every effort will be made to assure the safety of all.  I further understand that any liability will be limited to the extent of existing insurance policies, and that Born To Dance and their staff and employees shall be held blameless.  In case of accident or illness, Born To Dance is authorized to secure emergency medical treatment in the event I cannot be reached.  I agree to be financially responsible for any such treatment.

Born To Dance retains the right to use photos and or videos for promotional purposes without compensation to dancers, their parents/guuardians, or others.

DANCE CLASSES MUST BE PAID IN  ADVANCE.  UNFORTIONATELY WE CANNOT GIVE REFUNDS.  PLEASE ASK ABOUT OUR "MAKE-UP" CLASS POLICY.

Sign______________________________________________________



Date______________________________________________________

How did you hear about Born To Dance?__________________________