Patsy’s Dance Studio

2021-2022 Registration Form

Registration Fee is $20 per Family

1.Child’s Name _____________________________Age___ Birth Date __________

Class time(s)________________________________________________________

2.Child’s Name ______________________________Age___ Birth Date _________

Class time(s)________________________________________________________

3.Child’s Name _____________________________Age___ Birth Date __________

Class time(s) ________________________________________________________

Parent’s Name & Address _____________________________________________

Contact Cell No. _________________Emergency Contact No.________________

Email Address: _____________________________________________________

PHOTOGRAPH RELEASE:  I give permission for photos of my child to be taken during dance class. Photos will be used on social media and for advertisement.

DROP OFF/PICK UP Parent/Guardian is responsible for the safe/timely drop-off & pick up of child at the lower back door entrance at Mid-City parking lot on Locust St. before/after class time.  Waiting room will NOT be open again this year.  No parents or siblings are to be in dance studio during class time.

Put dancer’s name on all shoes & articles of clothing, PLEASE.

I HAVE READ, UNDERSTAND AND AGREE WITH ALL OF THE ABOVE

 

Signature of parent/legal guardian or adult student:______________________   Date:______________

 

FOR OFFICE USE ONLY Payment made on registration day 8/19/21:    $ ________

Registration Fee $ ____________  Payment made for Monthly fee(s)   $ ________.