Person Responsible For Payments*

First Last

Address*

Street Address City State ZIP Code

Email*

Phone

How many students are you registering?*

Student 1

Students Name*

First Last

D.O.B.*

Age*

Class Selection

Please pick age appropriate classes that you are interested in.

Ages 3 - 6

Tumbling
Pre Dance (3 - 4yrs)
Pre Ballet (4 - 5yrs)
Pre Tap (4 - 5yrs)

Please select all that you are interested in.

Ages 6 - 8

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 9 - 12

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 13+

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Technique Ages 6+

Tap
Jazz
Ballet

Please select all that you are interested in.

Student 2

Students Name*

First Last

D.O.B.*

Age*

Class Selection

Please pick age appropriate classes that you are interested in.

Ages 3 - 6

Tumbling
Pre Dance (3 - 4yrs)
Pre Ballet (4 - 5yrs)
Pre Tap (4 - 5yrs)

Please select all that you are interested in.

Ages 6 - 8

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 9 - 12

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 13+

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Technique Ages 6+

Tap
Jazz
Ballet

Please select all that you are interested in.

Student 3

Students Name*

First Last

D.O.B.*

Age*

Class Selection

Please pick age appropriate classes that you are interested in.

Ages 3 - 6

Tumbling
Pre Dance (3 - 4yrs)
Pre Ballet (4 - 5yrs)
Pre Tap (4 - 5yrs)

Please select all that you are interested in.

Ages 6 - 8

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 9 - 12

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Ages 13+

Ballet
Hip Hip
Jazz
Tap
Cheer

Please select all that you are interested in.

Technique Ages 6+

Tap
Jazz
Ballet

Please select all that you are interested in.

Additional Information

What is the earliest time you can attend a class?

Is there a day that does NOT work with your schedule?

Any other comments

I understand the above information is true and correct and any and all medical problems have been identified. I also understand that tuition is due on the 1st of every month. Tuition paid after the 10th of the month will be charged a $10 late fee. Tuition is non-refundable. Any fees 45 days past due will result in the dancer not being admitted to classes. I also understand that a costume fee of $65 is owed on or before November 1st. Costumes are non-refundable. I also understand Hit The Floor Dance Studio’s withdraw policy. There will be a $25 charge for returned checks.

Waiver

I understand that a physician should approve any form of exercise. It is agreed that I waive and release all rights and claims for damages that I and/or my child might have against Hit The Floor Dance Studio, LLC, instructors, staff, or any Hit The Floor Dance Studio representative(s) for any injury in connection with dance programs and other activities relating to such programs including but not restricted to competitions, performances, and recitals. The risk of such programs is fully understood. In case of Emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I nearby gibe my permission to the licensed health-care practitioner selected by the adult leader in charge to secure proper treatment.

Consent for Use of Photography

I grant to Hit The Floor Dance Studio and its representatives, assignees and employees the right to use photographs of the registrant for use of publicity, illustration, advertising, and Web content.

All of the above is true and correct. I am the responsible party for all expenses incurred by the registrant.

Total

$0.00

Digital Signature*

Today's Date*

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Student Registration

Student Registration

Student 1

Class Selection

Student 2

Class Selection

Student 3

Class Selection

Additional Information

Waiver

Consent for Use of Photography

All of the above is true and correct. I am the responsible party for all expenses incurred by the registrant.