Patsy’s Dance Studio
2021-2022 Registration Form
Registration Fee is $20 per Family
1.Child’s Name _____________________________Age___ Birth Date __________
2.Child’s Name ______________________________Age___ Birth Date _________
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) $ ________.