Lisa Fristoe’s Dance Express

To register, complete the registration and waiver, photo release & conduct agreement.   Send tuition, registration fee and this form to:

Dance Express, 5214 Holly Ridge Drive, Raleigh, NC 27612.  Make checks payable to Dance Express.

REGISTRATION FORM for 2007-2008

Student’s Name__________________________________________________

Parent’s Name  _______________________________________________________________________________________________

Address             _______________________________________________________________________________________________

Zip Code           _____________________              

School Attending  ______________________________________________________                          Grade  _____________________

Telephone (Home) ____________________________ (Work) _____________________________(Cell) ________________________

Student’s Birthdate ______________________                                         e-mail Addr  _________________________________________

Parent’s Occupation ______________________________________                 _____________________________________________

                                                                (Father’s)                                                                                      (Mother’s)

Emergency Contact ________________________________              Contact’s Phone Number ________________________________  

Medical Problems or Special Needs _______________________________________________________________________________                                

Please list the classes you would like to register for

Class Title	Day	Time	Hours
1
2
3
4

Please note:  Confirmation notices will be

sent via e-mail.

Tuition for 1^st Trimester       $____________

Registration Fee                 $ 35.00 – per student

Total Enclosed                    $____________

WAIVER, PHOTO RELEASE & CONDUCT AGREEMENT

I, ___________________________________, understand and agree that I am solely responsible and liable for all accidents or injuries caused by acts of

    (Parent/Guardian’s Name)

___________________________________ while on the studio’s premises or other event sponsored or associated with Dance Express, and I shall indemnify and hold

      (Student’s Name)

Dance Express and it’s employees harmless from all liability, of whatsoever nature, for such accidents or injuries caused by the above mentioned student, including court costs, expenses and reasonable attorney’s fees.  Parent’s give permission for their child to be videotaped and/or photographed during the dance year to use for promotion, website and in print for Dance Express promotional purposes only.  All students and their families are expected to be respectful of Dance Express facilities and agree to follow the following rules: no food or drink in studio, only wear dance shoes on the studio floor, proper attire and shoes worn to class, no horseplay in lobby.

I understand a student with excessive absences in a class might lose their spot in that class and need to be switched to another class for a variety of reasons.  This decision will be made by the director.

I hereby certify that I have read and understand this agreement.

___________________________________________________

Parent’s/Guardian’s Signature                                            Date