Dance Express
To register, complete the registration and waiver / release form. Send tuition, registration fee and this form to:
Lisa Fristoe, 217 Trails End Court, Raleigh, NC 27614. Make checks payable to Dance Express.
Student’s Name__________________________________________________
Parent’s Name _______________________________________________________________________________________________
Address _______________________________________________________________________________________________
Zip Code _____________________
School Attending ______________________________________________________ Grade _____________________
Telephone (Home) ____________________________ (Business/Daytime) _____________________________
Student’s Birthdate ______________________ e-mail Addr _________________________________________
Parent’s Occupation ______________________________________ _____________________________________________
(Father’s) (Mother’s)
Emergency Contact ________________________________ Contact’s Phone Number ________________________________
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Class(es) you are registering for: |
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Confirmations will be
sent via email.
Tuition
$ ______
Reg Fee Free
Total Enclosed $ ______
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
(Student’s Name)
hold 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