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                                                                           Dance & Theater Arts Studio
                                                                                       Registration Form

Student Name:_____________________________________ D.O.B.________________
Parent(s) Name(s) 1._______________________________________________________
                              2. ______________________________________________________
Address:________________________________________________________________
Primary Email(s)__________________________________________________________
Home Phone #______________________Cell # _____________________Work #_____________________
Emergency Contact:_________________________________Phone #____________________

             Special Needs or Allergies: _________________________________________________
              _______________________________________________________________________

Class: 1._________________________________ Day______________ Time ________
           2._________________________________ Day_______________ Time________
           3._________________________________ Day_______________ Time________

I, the undersigned, understand that dancing and all physical activity carries certain risks.  I do hereby agree to release  Dance & Theater Arts Studios, its directors and employees, from any and all claims for personal injury or property loss, to myself/ my child, sustained while participating in said classes and activities in conjunction with this studio.  Parents are responsible to pay for any physical damage to the studio incurred by a student's negligence.
   I have read, and comply with the above statement:
                             Signature:______________________________________ Date:__________________

                Office Use Only
                SM I DEPOSIT / PIF __________ DATE__________ PAYMENT TYPE_________ CK #__________ 
                        BALANCE______________ DATE__________ PAYMENT TYPE_________ CK #__________

                SM II DEPOSIT / PIF__________ DATE__________ PAYMENT TYPE__________CK #_________
                          BALANCE_____________ DATE__________  PAYMENT TYPE__________CK#__________