Center Stage Registration Form 2006-2007
Dancer’s Name: _____________________________________________
Parent’s Name:
_____________________________________________
Address:
___________________________________________________
___________________________________________________
Day Phone: ________________ Evening Phone:
__________________
Cell: ______________________
Email:__________________________
Emergency contact name:
____________________________________
Emergency Contact Phone:
___________________________________
Birthday: __________________ School:
________________________
Grade: ______________________
This will be my ________ year dancing at Center Stage.
How did you hear about us?
__________________________________
Please return this registration form and tuition payment
to:
Centerstage1.com
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In consideration of the opportunity to participate in the classes and programs of Center Stage, I release and discharge Center Stage, its Directors and Agents from any claims, demands, liabilities or damage arising from the participation of my child in any classes or programs sponsored by Center Stage. If the parents or Emergency Contacts cannot be reached in case of an emergency, consent is given for my child to receive medical or surgical care as recommended by the physician or hospital. I received and read a copy of the studio polices and will adhere to them.
________________________ _________________________
Parent/ Guardian Date