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?__________________________