ISABELLE’S DANCE TIME
SUMMER REGISTRATION FORM 2010
|
|
Student Name
|
|
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
|
|
School & Grade
|
Birth Date
|
|
Please CIRCLE the
classes you wish to enroll in and the dates.
All Classes are in July.
Then total your
hours for each class.
|
Beg/Inter
Ballet
M.
5
12
19
26
|
|
Beg/Inter
Jazz
T.
6
13 20 27
|
|
Pilates
W.
7 14 21 28
|
Tap
Rhythms (Open Level)
TH.
8 15 22 29
|
|
Stretch
& Strengthen
M.
5
12 19 26
|
|
Inter/Adv
Ballet
T.
6 13 20 27
TH.
8 15 22 29
|
|
Turns
& Leaps
W.
7
14 21 28
|
|
|
Contemporary/Lyrical
M.
5 12 19 26
W.
7 14 21 28
|
|
Inter/Adv.
Jazz
T.
6 13 20 27
TH.
8 15 22 29
|
|
Tap
Time Steps
W. 7 14 21 28
|
|
|
Zumba
M.
5 12 19 26
|
|
Tap
Variety
T. 6
13 20 27
|
|
Improvisation
W.
7 14 21 28
|
|
|
D.T.T.C.
M.
5 12 19 26
TH.
8 15 22 29
|
|
Partnering
T.
6 13 20 27
|
|
Street
(ages 13 & up)
TH.
8 15 22 29
|
|
|
Total
Number of Classes: _____________
Total
Amount Due: _____________
Method
of Payment: _____________
Date of Payment: ___________
|
|
| |
|
|
|
I understand and agree to
have my child or self follow policies regarding dress requirement, attendance,
and tuition.
X
Date
Guardian or Student
Signature
|
Isabelle's Dance Time Medical Information and
Liability Waiver Form Summer 2010 |
| 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:
- That
I wish to be enrolled in dance classes at Isabelle’s Dance Time, knowing
that
this involves physical activity.
- 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).
- 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)
|
