ISABELLE’S DANCE TIME & GAIL’S SCHOOL OF DANCE

Princess Dance Camp REGISTRATION FORM

Student Name:                                                                                         Name of Favorite Princess:

Address

City

State

Zip Code

Tel #1

Tel #2

Name: Parent/Guardian #1

Name: Parent/Guardian #2

In case of emergency, please notify

Person (s) responsible for tuition

Princess Day Camp Days: (Circle the days you wish to enroll in.)

July 8         July 12        July 20          July 28

Birth Date

           ISABELLE’S DANCE TIME/ GAIL’S SCHOOL OF DANCE,   MEDICAL INFORMATION AND  WAIVER FORM

NAME: ________________________________________________

  PHYSICIAN’S NAME: ________________________________PHONE #______________

  HOSPITAL: _____________________________________________

   Are you currently taking any medications? _______

   Explain:__________________________________________________________________________________

_________________________________________________________________________________________

  Known Allergies:__________________________________________________________________________

  Please list any past or present injuries or physical restrictions?____________________________________

  _________________________________________________________________________________________

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 & Gail’s School of Dance Summer Workshop, knowing that this involves physical activity.

2.      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):

3.      That in consideration for my 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 & GAIL’S SCHOOL OF DANCE, 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 the above note 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)