Isabelle's Dance Time Registration Form 2008-2009

Student Name

Address  

City  

State

Zip Code

Tel #1  

Tel #2

Email:  

 

Name: Parent/Guardian #1

Name: Parent/Guardian #2  

In case of emergency, please notify  

Emergency telephone  

Person (s) responsible for tuition

School & Grade  

Birth Date

Pre-Ballet 

Ballet 

Jazz 

Other  

Pre-Ballet 1

 

Basic Ballet

 

Basic Jazz

 

Tap

 

Pre-Ballet 2

 

Basic/ Intermediate Ballet

 

Basic/ InterJazz

 

Hip Hop

 

 

 

Intermediate Ballet 1

 

Intermediate Jazz

 

Dance Company (DTTC)

 

Intermediate Ballet 2 (M & W) Advanced Jazz (Tu & Th) Partner/ Lyrical

 

 

Advanced Ballet ( M & W)

 

 

 

 

 

 

 

Pointe ( Th )

 

 

 

 

Previous training?  Please list past experience in dance (include styles of dance and number of years)    

Name of previous dance school:

How did you hear about our school?  

Newspaper 

Phone Book 

Web site 

Performance 

Word of Mouth 

Referral Name:          

Other 

 

I agree to have my child or myself  follow all dress, attendance and tuition policies.

X________________________________                                 Date_______________________
        Guardian Signature





Isabelle's Dance Time Medical Information and Liability Waiver Form 2008-2009
Name of Student:

 
Physician's Name:                                                             Phone # 
Are you currently taking any medications?               Explain:

 
Known Allergies:
Please list any present injuries or physical restrictions:

 
In case of emergency, who should be notified:                                         

Emergency Telephone #'s: 
List Insurance Company and Policy # if you desire:

 



I THE UNDERSIGNED, individually or as a Parent/Guardian on behalf of a minor, being over the age of (18) and of sound mind do declare:  

  1. That I wish to be enrolled in dance classes at Isabelle’s Dance Time, knowing that this involves physical activity.
  1. That I am in good health or my physician has certified that I would not be harmed by my participation in any activity associated with the class(es).
  1. That in consideration for may acceptance into this program, I herby for myself, my heirs, executors, administrators and assignees, waive, release and discharge any and all rights, demands, and claims for damages that I may have against ISABELLE'S DANCE TIME, ITS EMPLOYEES, MEMBERS OR AGENTS, for any and all injuries and losses related to me during the course of, or in any way connected with above noted dance program.  I assume responsibility for my own medical and emergency expenses in the event of an accident, illness, or other incapacity.  This release is effective for the period of one year from the date given. 

____________________________________________________Date: ______________

Signature (Parent/Guardian if under 18)    
 

(Mail or deliver these forms to:  Isabelle Cook, 4120 South Sullivan Road, Veradale, WA 99037)