Home    About SheLor    SSOD Blog     Staff    Photo Album    Contact   

 

 

2006-2007 Registration Form

 

 

 

(Fields in Red are Required)

Student Name
Students Address
City		Zip Code
Phone #1		Emergency Phone #2
E-mail
Birthday :	-- mm/dd/yy	Age:

Parent or Gardian (First & Last Name of each parent):

1.  First:		Last:		E-mail:
2.  First:		Last:		E-mail:

Dance Years Experience:            Tuition per Month:     

Classes Registering For:

	Description	Day/Time	Teacher
1.
2.
3.
4.
5.
6.

  I give SheLor School of Dance and any Health Care Provider receiving referrals, to render emergency medical care and treatment to the student, named previously in this registration form, in connection with any illness or injury incurred while at the premises of SheLor School of Dance or while participating in an event for SheLor School of Dance.

 

I also give permission to SheLor School of Dance to use photographs of my child and/or dance student for the purposes of advertising, website use or any miscellaneous printed materials associated with dance and SheLor School of Dance. (Checking this box constitutes a Digital Signature of Agreement).

Health Insurance Number 

List any and all allergies that may cause treatment or emergency situations, List any medications that may be used during class, (i.e.: asthma meds), List any illnesses or conditions we should be informed about:

©2006 YCS Global, LLC. All Rights Reserved.