Student Registration

Address *

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City

State

Zip Code

Country

Student Date of Birth (MM/DD/YYYY) *

Primary Phone # *

Primary Email *

Classes

Check all that apply.

***Payment is due upon enrollment - spot is only reserved once payment has been received.

Parent/Guardian Information

#1 Address (If different from student) *

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City

State

Zip Code

Country

#1 Relationship to Student *

Mother Father Legal Guardian Other

*If Other, please specify: *

Emergency Contact Info

*Please list anyone in addition to parents/guardians who are permitted to pick up your child:

Student Medical History

Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?

Terms of Agreement

I hereby give permission for my child to be photographed. I understand the photos could be used to share during power point presentations, for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Danica’s School of Dance.

Photo Release Agreement: *

I agree to the Photo Release Terms I do not agree to the Photo Release Terms

Studio Liability Release Agreement:

DSD is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).