The Dance Company

Registration Form – Fall 2006

2006 –2007 semester begins September 5th, 2006

This form can be cut and pasted into a word document for printing 

Student 1 Name _____________________________________________ Age _______   DOB ___________ Grade_______

Student 2 Name _____________________________________________ Age _______   DOB ___________ Grade_______

Address_________________________________________________________________________________________________________________                                                                   
City/State/Zip code___________________________________________________________________________________
Home Phone ________________________________________________________________________________________

Previous Dance Experience_________________________________________________________________________________________________  

Parent 1  Name -Phone/ Home, /Work/Cell Phone____________________________________________________________

Parent 2 Name Phone/ Home, /Work/Cell Phone_____________________________________________________________

Would you like to receive school updates, invoices, and information via e-mail? no ____yes _______

If yes please send to   E-mail: ___________________________________________________________________________

Please list two people whom we may contact in the case of an emergency:

Emergency Contact #1_______________________________________________________Phone: ____________________

Emergency Contact #2 __________________________________________________________________________Phone:____________________

In the event of a minor injury (fall, scrape, strain, or sprain), the faculty of The Dance company will apply ice, elevate and if necessary contact the parent or the contact person(s).  In the event of a medical emergency, the faculty of The Dance Company will call 911, and then will attempt to reach the parent or the emergency contact person(s). The Dance Company faculty should be informed of any physical limitations (past injuries) or medical conditions that may require special attention for the student: _______________________________________________________________________

Where did you hear about The Dance Company?  _______________________________________________________________________________

PLEASE READ AND SIGN THE FOLLOWING STATEMENT
In connection with my participation in classes provided by Shauna Junek and The Dance Company, I understand and voluntarily assume all risks inherent in the nature of the activity; and waive all claims, costs, liabilities, expenses and judgments against The Dance Company, Shauna Junek, the facility and their respective directors, officers, agents, representatives and employees from all claims, costs, liabilities, expenses and judgments arising out of my participation in the program. I further agree to indemnify The Dance Company, Shauna Junek and the facility, and their directors, officers, agents, representatives and employees and hold all of them harmless from any and all claims, damages, actions, liabilities and expenses which may be asserted on behalf of myself/child in connection with any damages or injuries arising out of my participation in the program.

I understand that missed classes must be made up during the current school year.     Initial_____

I have read and acknowledge and agree to the policy and fee structures.      Initial_____

I have read and understand the policies regarding non-refundable tuition, make-up classes and payment obligations. 

                                                                                                                                              Initial ____

I certify that I/my child is in good health and capable of participating in all activities and classes.     Initial_____

I understand that missed classes may result in a required private lesson for my child, the fee may range from 10-30 dollars   Initial_____

I have read the policies and procedures and understand that if my child arrives without proper footwear, attire, or more then 20 minutes late they may be asked to view class rather then participate.  I understand that this is for the safety of the student.    Initial_____

I am under the understanding that I am required to follow school policies; I will show the school consideration of their commitment to my child by  giving 30 days written notice prior to discontinuing classes. Fees will not be reimbursed without written notice or Doctors certificate      Initial_____

Parent Signature________________________________________________________________________ Date_______________________

Children's names _____________________________________________________________________________________