Studio of Performing Arts

 

Registration Form

 

Student Information                                                         $30.00 Fee Paid: _________

 

Name: _________________________________________Age: __________ DOB: ____/___/___

 

Address: _____________________________________________________________________

                (Street)                                             (City)                                      (State)      (Zip)

 

Phone: (Home): ____________________(Work):   ________________Years Experience: _______

 

                                                               

  Parent or Guardian: (if different from Child)

 

Name: _____________________________________________________________________

 

Address: _____________________________________________________________________

                 (Street)                                           (City)                                     (State)       (Zip)

 

Phone: (Home): __________________(Work):  ________________(Cell): _________________

 

E-Mail Address:   ____________________________________________________

 

Name and Number of who to Contact for Emergency or Cancellation

 

Name: _________________________________Phone: _____________________

 

How did you hear of the “Studio of Performing Arts”? ___________________________________________________________________

 

     By signing, I indicate I have read and understand the billing procedures to be used and I agree to said terms, including your right to suspend lessons to my child in the event of non-payment of fees for more than 60 days.

 

          Signature: ___________________________Date: _____________________

 

     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: _______________________

 

       I look forward to the upcoming year.   If you have any questions or concerns during the year, do not hesitate to contact me.

 

                                                                                              Jeanne Dion Arsenault

                                                                                                   Director  & Owner