2011 – 2012 Registration Form

Dancer’s Name:  __________________________

E-Mail Address:  __________________________

Home Phone:  ___________  Work:  ____________  Cell:  ___________

Address:  _________________________________________

City:  ____________________   State:  ____________  Zip:  _______

Date of birth and school year:  __________________________

Parent/Guardian:  __________________________

Years of dance experience:  _____

Emergency Contact:  ___________________________

Classes Desired               Class                     Day                       Time

·        ___________________________________________

·        ___________________________________________

·        ___________________________________________

·        ___________________________________________

 (Please refer to the enclosures to choose the best class for your child)

Although every effort is made to create a safe environment, I realize there is always risk of accident.  If necessary, I authorize Barbie’s Encore Dance Productions to administer first aid treatment and/or emergency treatment for my child on my behalf.  I further release Barbie’s Encore Dance Productions from liabilities for injury or damages arising out of personal injury of any kind.

Parent/Guardian Signature:  ___________________________________

I understand that I am enrolling for the 2011-2012 dance year.  I have read the Parent Handbook and agree to the policies of Barbie’s Encore Dance Productions.  I further understand that I am responsible for all tuition payments as registered until a Registration Change Form is submitted 30 days prior to date of change.

Parent/Guardian Signature:  ___________________________________