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Fee per Student:
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Room:
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Release of Liability and Medical Emergency
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As the legal parent or guardian, I release and hold harmless Dothan School of Dance, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises, any premises under the control and supervision of Dothan School of Dance, its owners and operators or in route to or from any of said premises. The undersigned gives permission to Dothan School of Dance, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian.
I've read the above and agree.
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Payment
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Full payment is required to receive a spot in the class. All Payments are non-refundable.
I've read the above and agree.
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Photography and Videography Release
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I hereby grant to Dothan School of Dance the irrevocable and unrestricted right to use, reproduce, and publish photographs or videos of my child for editorial, trade, advertising, or any other purpose or manner and medium. I hereby release Dothan School of Dance and its owners and teachers from any and all claims, actions, and liability relating to use of said photographs or videos.
I've read the above and agree.
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Dress Code
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Dancers will need a leotard, pink tights and pink ballet shoes for Mommy & Me class.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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