La Danse Workshop Registration
Location
Registration Date
Student Name
Age
Birthday
Parent or guardian Name
Mailing Address
Street
City
Zip
Home Phone
Cell Phone
Emergency contact
Contact Phone
Email
This is our main source of communication and billing.
How did you hear about us?
Friend's Name?
Newspaper?
Former Dance Experience
Interested in taking the below forms of dance
Chosen form of paying
Release
La Danse Workshop’s insurance covers liability only. In consideration of accepting this application, I hereby waive and release any claims due to any and all injuries that might be sustained by my child during this program.
I hereby assume all financial responsibility for above students enrolled at La Danse Workshop.
I give La Danse Workshop permission to use photos of my child in advertisements and/or promotions.
Note: Missed classes are not refundable. Snow cancellations are non refundable. Make up lessons are available .
Parent electronic Signature
Please click the submit button
