Studio of Performing Arts

Re-Registration Form

2013-2014 Dance Year

 

You can Pre Register by completing the bottom portion of this form and mail it along with Registration Fee to:

Jeanne Arsenault

3 Marks Court

Londonderry, NH 03053

 

Register before July 1st 2015 Fee: $15.00

Register after July 1st 2015 Fee: $20.00

 

 

Students Name: ____________________Birth Date:______

 

Parents/ Guardian Name: _________________________________

 

Address: ______________________________________________________ 
 (Street)                                         (City)                   (State)   (Zip)

 

Phone: (Home)_________(Work)_________(Cell)__________

 

E-Mail Address for cancellations:______________________________

 

Emergency Contact: _______________________________

                        Phone:_______________________________

                Cell Phone:_______________________________

 

     By signing, I hereby give my permission for my child to participate in the dance lessons and or program and hereby waive and release any claim of liability for damage or injury caused during participation, unless the injury is the result of intended and willful conduct.

 

  Signature: ________________________________   Date: ___________

 

Please place Check for Class(es) you are Interested in taking:

Tap [    ]Jazz [    ]Modern [    ]Ballet [    ]Pointe [     ]Hip Hop [    ]

                                                                                           (By approval only)