18Miss Melanie’s Dance Zone
     
    2021 - 2022
    ​Registration Form
     
     
    Student Name:________________________________________
    Address:_____________________________________________
    City, State, Zip:_________________________________________
        Phone:  ___________________  Cell:  ______________________     
    Email:  _______________________________________________
    Date of Birth:  ________________________    Age:  ____________
    Parent/Guardian Name:___________________________________
     
     
     
    Classes requested:  ______________________________________
    _____________________________________________________
    _____________________________________________________
     
     
     
    Please list any medical, health concerns, or allergies that I should be aware of:  __________________________________________________________
    __________________________________________________________
     
     
     
    I/We understand that there are some physical risks involved in attending dance classes.  I/we hereby release Miss Melanie’s Dance Zone, and it’s staff from any and all claims for injuries incurred at the studio, competitions, workshops, recital, or any other activities that are associated with this studio.
     
    Student Signature:  ___________________________________________
    Guardian Signature (if student is under 18): _________________________
    Date: ______________________________________________________