SB CM Registration

Creative Movement
Saturday 10:45 - 11:30

Contact One:

This contact should be a primary caregiver of the dancer. This contact will receive class emails and information.

* Indicates required field

Name *

First

Last

Relationship to Dancer *

Postal Address *

Email *

Cell Phone Number *

Home Phone Number *

Contact Two:

This person will ONLY be contacted in cases of emergency when Contact One cannot be reached.

Name *

First

Last

Relationship to Dancer: *

Cell Phone Number *

Home Phone Number *

Dancer Information:

Name *

First

Last

Gender *

Birthdate *

Current Age *

Grade Level *

Name of School Child Attends (If applicable) *

Known Allergies *

Notes or Concerns for Teacher *

Policies

Attendance and Tuition: Tuition is per session, not class. Tuition will not be decreased for illness, travel, or family obligation; however, make-up dates are available for any of these instances.. If a class is cancelled due to weather a make-up day will be assigned.

Please Select *

I have read and understand.

Liability: I am aware that movement and dance classes carry a risk of physical injury. I agree that Mathews Dance Studio and staff shall not be liable in any way for injuries sustained during any of its functions or classes.

Please Select *

I have read and understand.

Publicity: Mathews Dance Studio shall have the right and permission to use, publish and/or reproduce videos and photographs taken during MDS functions and classes.

Please Select *

I have read and GIVE permission. I have read and DO NOT give permission.

Submit

Creative MovementSaturday 10:45 - 11:30

Contact One:

Contact Two:

Dancer Information:

Policies

Creative Movement
Saturday 10:45 - 11:30