DanZQuest

STUDENT REGISTRATION FORM

 

NAME:  ____________  _________________    ____________                           

                     (FIRST)                                            (MIDDLE)                                                            (LAST)

 

ADDRESS:  _______________________________________________

CITY:  ___________________ STATE:  ________ ZIP:  ___________

 

BIRTH DATE:  ____/____/____       AGE:  ______     MALE / FEMALE

 

CLASS ASSIGNMENT

CLASS:  _______________________            DAY/TIME:  _______________________

 

CLASS:  _______________________            DAY/TIME:  _______________________

 

CLASS:  _______________________            DAY/TIME:  _______________________

 

PAYMENT PLAN

OPTION (A) YEAR IN FULL                   OPTION (B) MONTHLY PAYMENTS

 

AS IN ANY PHYSICAL ACTIVITY, THERE IS A RISK OF INJURY.  DANZQUEST DOES NOT CARRY INSURANCE FOR INDIVIDUAL STUDENTS AND REQUIRES THAT EACH STUDENT HAVE THEIR OWN MEDICAL COVERAGE.  BY SIGNING BELOW I AGREE NOT TO HOLD DANZQUEST LIABLE FOR ANY PHYSICAL INJURY AND UNDERSTAND THAT ANY MEDICAL BILLS INCURRED WILL BE MY SOLE RESPONSIBILITY.

 

_____________________________________     _________________________

                (PARENT OR GUARDIAN SIGNATURE)                                                         (DATE)

 

I have read the policies of DanZQuest Dance Studio (including clothing/shoe requirements, tuition fees).   

Parent or Guardian Signature___________________________________________________________

 

Company Students/Parents -  I have read the comapny contract and I agree to the terms and conditions with in.

Parent/Guardian and Student Signature___________________________________________________________

 

CONTACT INFORMATION

MOTHER:  __________________________                     FATHER:  ____________________________

WORK/CELL:  __________________________                   WORK/CELL:  ____________________________

HOME:       __________________________                              HOME:    ____________________________

 

E-MAIL ADDRESS FOR DANZQUEST NEWS ECT.   __________________________________                                     

EMERGENCY CONTACT:  _________________________________________________

 

ALLERGES_____________________________________________________________________