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| - $5.00 Registration Fee per family will be charged at Registration. 2009-2010 Registration Form Dance Attitude 6372 S. Military Rd Grayling, MI 49738 989-390-5661 Studio location: Craf Center, Roscommon ___Returning Student ___New Student Class____________ Class____________ Class____________ IMPORTANT: If there is any question in the mind of the parent about the health of this participant, a complete health examination should be secured from their physician. PARTICIPANT’S NAME_______________________________________ BIRTHDATE_______________ AGE_______ GRADE________ PARENT/GUARDIAN__________________________________________ MAILING ADDRESS_____________________________CITY______________ HOME PHONE________WORK PHONE________CELL PHONE________ E-MAIL ADDRESS:___________________________________________ EMERGENCY CONTACT______________________________________ (NAME / PHONE) ALLERGIES_________________________________________________ RESTRICTIONS ON ACTIVITIES_________________________________ PARENT AUTHORIZATION: I agree that by signing this form I am responsible for payment of lessons, costumes, and other related costs associated with my child’s acceptance as a student. I have read the studio policies and fully understand them. I agree to allow the Dance Attitude staff to take photographs and videotape my child or my child’s class for archival purposes and studio promotional use. My child is in good health at this time and has permission to engage in all event activities unless I have indicated otherwise. I understand that the Dance Attitude staff will exercise every reasonable precaution to protect the welfare of each student. In case of emergency where I cannot be reached, I hereby give my permission for the teacher in charge to secure emergency medical and surgical treatment, and non- surgical medical care for my minor child. PARENT/GUARDIAN____________________________________DATE__________ *THIS APPLICATION MUST BE SIGNED FOR ADMISSION* |