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Dance Etc. Studio of Dance Registration Form

Student Name_____ Birth date_____ School_____ Grade_____ Medical Info/Health Concerns_____ Parent/Guardian Name_____ Mailing Address_____ City_____ State_____ Zip Code_____ Home Phone Number (_____) _____ Email_____ Cell Phone Number (_____) _____Work Phone Number (_____) _____ Emergency Contact Name_____ Relation to Student_____ Phone Number (_____) _____ MEDICAL RELEASE In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by staff or emergency personnel.

Bad Weather / Holidays - The studio will not necessarily close for snow days, regardless if area schools are closed, since many times roads are clear and safe by 3:00 p.m

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