Registration Form - Mathews Dance Studio

Student Contact Information:

* Indicates required field

Name *

First

Last

Birthdate (mm/dd/yr) *

Mailing Address *

Email *

Phone Number *

Allergies or Health Conditions Your Instructor Should Take Into Consideration: *

Emergency Contacts

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Studio Policies:

We will occasionally take photographs and videos during class. Do we have permission to use your photo in our advertising or class emails?

Please Respond: *

Sure! No Thanks.

While I am very excited to participate in this dance class, I also understand that with physical activity comes risk of injury. If I have any pre-existing conditions that my instructor, Haley, needs to know about I will disclose them before starting class.

Please type your name below to serve as your signature.

Signature *

Submit