MISS MELANIE'S DANCE ZONE
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18Miss Melanie’s Dance Zone
2021 - 2022
Registration Form
Student Name:________________________________________
Address:_____________________________________________
City, State, Zip:_________________________________________
Phone: ___________________ Cell: ______________________
Email: _____________________________________________
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Date of Birth: ________________________ Age: ____________
Parent/Guardian Name:___________________________________
Classes requested: ______________________________________
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Please list any medical, health concerns, or allergies that I should be aware of: __________________________________________________________
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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): _______________________
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Date: ______________________________________________
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Submit