Home
Students | Parents
Covid-19 Policies & Procedures
Dress Code
Studio Polices & Procedures Withdraw Form
Studio Closures/Season Dates
Gallery
Class Schedule
Tuition
Contact
Meet the Instructors
Nimbly Dance Shop!
Home
Students | Parents
Covid-19 Policies & Procedures
Dress Code
Studio Polices & Procedures Withdraw Form
Studio Closures/Season Dates
Gallery
Class Schedule
Tuition
Contact
Meet the Instructors
Nimbly Dance Shop!
Printable Registration Form:
Please
Download the Registration Form
below,
Print it
, and
Fill Out
all the applicable information.
dsd_2016_student_registration_form.doc
File Size:
138 kb
File Type:
doc
Download File
dsd_2016_student_registration_form.pdf
File Size:
153 kb
File Type:
pdf
Download File
Or fill out the Electronic Registration Form below:
Student Registration Form
*
Indicates required field
Student Name
*
First
Last
Gender
*
Female
Male
Address
*
Line 1
Line 2
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
Name #1
*
First
Last
#1 Phone Number
*
#1 Address (If different from student)
*
Line 1
Line 2
City
State
Zip Code
Country
#1 Relationship to Student
*
Mother
Father
Legal Guardian
Other
*If Other, please specify:
*
Emergency Contact Info
Name
*
First
Last
Phone Number
*
*Please list anyone in addition to parents/guardians who are permitted to pick up your child:
Name #1
*
First
Last
Phone Number #1
*
Name #2
*
First
Last
Phone Number #2
*
Student Medical History
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
Student Injury/Medication
*
Yes
No
If YES, please specify:
*
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).
Parent/Legal Guardian Name
*
First
Last
Form Completed (MM/DD/YYY)
*
Submit