School Attending in Fall & Grade:
Place of employment & Work Phone:
Place of Employment & Work Phone:
Emergency Contact Name & Relation:
Where did you hear about us?
Summer Subject Options: (level to be determined by director)
Fall Subject Choices: (level to be determined by director)
I hereby permit my child, herein indicated on this form, to participate in dance, tumbling, yoga, martial arts and any other activities of the dance center, and to receive instruction in such subjects from the dance center, and its staff and associates. I understand that such participation and instruction require the performance of physical exercise by my child(ren), which necessarily involves the risk of personal injury to my child. I hereby release Dance Visions, LLC and any of its staff and associates from any responsibility or liability whatsoever for any injury of any kind to my child arising out or in the course of his or her participation in any activity at the dance center, while on the premises, or as a result of any instruction received by my child(ren) from any of the staff or associates of Dance Visions, LLC. I also understand that I am responsible for payment of all services rendered and any other items that are on my account regardless if my child ceases to take class at Dance Visions LLC. I understand that all registration fees and costume deposits are non-refundable reagrdless of whether my child(ren) finishes out the session/season. I agree to pay all collection agency and legal fees that may arise if my account becomes delinquent. By checking the box below I agree to the terms and conditions of the release statment above