D & G Dance Company registration form

Registration Steps

  1. Fill out info and class request
  2. Ensure you fill in the required fields
  3. Enter full 10 digit phone number
  4. Click "Submit"
  5. Wait for email confirmation


dg_top

 

* Required Fields

Parent Or Legal Guardian Name*: Day Phone*: Verify Day Phone*: Evening Phone:
Address: Email Address*: Verify Email Address*:
City:
Zip:  
First Child Name*: Age:
Second Child Name: Age:
Third Child Name: Age:
Emergency Contact (other than parent/guardian)*: Contact num.*:
How did you hear about us?
Has your child had any previous dance training?
If yes above please select which child:
Select class or classes for first child:    


Select class or classes for second child:    


Select class or classes for third child:    


By Selecting "Yes" you agree to the Release of Liability Section below



  

Release of Liability:

As the legal parent or guardian, I release and hold harmless D & G Dance Company, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of D & G Dance Company, its owners and operators or in route to or from any of said premises.


Medical Emergency:

The undersigned gives permission to D & G Dance Company, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician _________________________ be called and that my child be transported to ______________________ hospital.


Payment and Tuition Information:

Tuition is due by the first of each session. If accounts are paid after the tenth of the month, there will be a $10.00 late fee applied to the account balance. There is a $25.00 returned check charge for any checks returned by the bank. Please review our studio policies.


I've read all of the above and the Studio Policies and agree.

_____________________________________________________________ Date___/____/___

Back