To register for fall classes which will begin on Monday, August 15, 2011, please complete the information below and return to the studio. There is a $25 non-refundable registration fee to hold each student's place in class. Please return your form and fee as soon as possible to obtain your place in class. Class sizes are limited and are placed on a first come first serve basis. You may return registration forms to the studio by dropping off in person, placing in the gold box in the lobby, mailing to address above, or dropping through our mailslot in the door on the right hand side of our building. Confirmation of your registration will be mailed out the end of summer before classes begin.
Student Name______________________________________________________________________________
Mailing Address_____________________________________________________________________________
City____________________________________________________________ Zip________________________
Parent/Guardian______________________________________________________________________________
Home Phone___________________________________ Cell Phone_________________________________
Age______ Date Of Birth_____________________ School Attending________________________________
Previous Years of Experience ( if new with Center Stage)_____________
Email Address_______________________________________________________________________________
Class(es) Registering For: (Please list age, class, subject, day, time)
____________________________________________________________________________________________
____________________________________________________________________________________________
Release Form
I do hereby acknowledge and agree that participation in classes and performances with Center Stage Dance
Company will be solely at the risk of this applicant and I do release Center Stage Dance Company, director, and
instructors from all claims that might arise from the applicant's participation in the said program.
I do hereby acknowledge that I am in good general health and can particpate fully in classes and performances.
Student Name____________________________________________________________________
Parent/Guardian Signature__________________________________________________________
Date___________________________________________________
Enclosed registration fee of $25
____cash ______check _____Visa/Mastercard/Discover/American Express
Card #_______________________ ________________________________ Exp. Date____________ Billing Zip Code_____________
We look forward to seeing you in August!
