WESTON DANCE ACADEMY REGISTRATION FORM

Student Name: _______________________________ Age: __________ DOB: __________________
Parent /Guardian Name(s): __________________________________________________________
Address: ______________________________________________________________________
Home phone: ______________________ Cell phone: _______________________________
Occupation: ______________________________________ Work phone: _________________________
Email Address: ________________________________________________
Emergency Contact: _______________________________________ phone:_______________________
(other than parent/guardian)
Medical Information: ___________________________________________________________________
(any physical limitations, allergies, asthma, seizures, etc.)
WESTON DANCE ACADEMY DOES NOT OFFER REFUNDS FOR REGISTRATION FEES, CLASSES MISSED, OR RECITAL COSTS. BY SIGNING THIS CARD, I PERMIT WESTON DANCE ACADEMY TO AUTHORIZE EMERGENCY MEDICAL TREATMENT. WESTON DANCE ACADEMY DOES NOT CARRY MEDICAL INSURANCE FOR ITS STUDENTS. IT IS REQUIRED THAT ALL DANCE STUDENTS BE COVERED BY THEIR OWN FAMILY INSURANCE POLICIES. WESTON DANCE ACADEMY, OR ANYONE ASSOCIATED, CANNOT BE HELD RESPONSIBLE FOR ANY INJURY THAT SHOULD OCCUR OR COSTS OF HEALTH CARE. IT IS UNDERSTOOD THAT THE STUDENT’S OWN POLICY IS YOUR ONLY SOURCE OF REIMBURSEMENT.
SIGNATURE: ____________________________________________________________ DATE:__________________________

 

WESTON DANCE ACADEMY

CLASSES CHOSEN:                                                                       DAY/TIME
_________________________________________                      ___________________________
_________________________________________                       ___________________________
_________________________________________                      ____________________________
_________________________________________                     ____________________________

REGISTRATION DATE: _____________________________________
TUITION PAYMENTS:
_______________________________________               ___________________________________
_______________________________________               ___________________________________
_______________________________________               ___________________________________
_______________________________________               ___________________________________
_______________________________________               ___________________________________

RECITAL PAYMENTS: _____________________________________

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