Student’s name _________________________________________________________ Date of birth _______________ Age ____________
(street) (city) (zip code)
Home telephone ____________________________________________ Email address _________________________________________
Mother’s name ____________________________________ Cell phone ____________________ Business phone _____________________
Father’s name ____________________________________ Cell phone ____________________ Business phone _____________________
Emergency contact (someone additional to names listed above)
________________________________________________________________________________________________________________ (name) (relationship) (telephone number)
Medical conditions & medications (include history of physical, mental, emotional or learning disorders)
Previous dance training (number of years, location, style of dancing)
How did you hear about DAC?______________________________________________________________________________________
I understand that all sessions and classes are pre-paid for and there are no refunds for weeks missed, cancelled or absent classes. I also understand that DAC WILL NOT PRO-RATE SESSION PRICES FOR "WEEKS MISSED" CANCELLED, OR ABSENT CLASSES. I understand that all studio policies, schedules and fees are subject to change. I understand that my classes may be terminated without refund or notice if I do not adhere to and comply with the studio policies. I agree to allow the Dance Arts Conservatory and it’s owners to use any written testimony, photographs or video/DVD footage taken of (myself/my child/family) in the advertising and promotion of the Dance School, all of its related activities, and any additional future business ventures made by the studio or it’s owners.
I UNDERSTAND THAT ALL DEPOSITS, FEE’S AND PAYMENTS MADE TO THE DANCE ARTS CONSERVATORY ARE NON-REFUNDABLE I HAVE BEEN GIVEN THE DANCE STUDIO POLICY AND RECITAL HANDBOOK AND I AGREE TO COMPLY WITH AND ADHERE TO ALL OF THE STUDIO POLICIES FOR AS LONG AS I AM A CUSTOMER OF THE DANCE ARTS CONSERVATORY.
(Parent or Adult Student Signature) (Date)