Registration
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Children aged 3-10 will enjoy craft, games, dancing and snacks
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
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ME
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OH
OK
OR
PA
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SC
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TN
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VA
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WA
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Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Does your dancer have any allergies?
*
Additional Information:
Event Waiver
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Release of Liability
As the participant or the parent of a participating child, I understand the risks of possible injury, damage or loss resulting from participating in the program. I do hereby fully release and discharge Wings Dance Studio, its officers and employees from any and all claims from injuries, damages, or loss which may occur to me or my children as a result of our participation in the programs. I have read and understand this statement.
Photo Consent
Wings Dance Studio is hereby granted permission to take photos for use in brochures, website, posters, advertisements and other promotional material the studio creates. Permission is also hereby granted to Wings Dance Studio to copyright such materials in its name.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Add Credit Card
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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