Class Registration – Center Stage Dance Studio, LLC.

Tell Us About Dancer

First Name:

Last Name:

Birth Date:

Age:

Grade as of September:

School Hours:

Physical Limitations:

Referred By:

Previous Dance Training:

Contact Information

Email Address: (Center Stage uses email as our primary means of communicating important studio information)

Street Address:

City:

State:

Zip:

Home Phone:

Parent 1:

Work Phone:

Cell Phone:

Parent 2:

Work Phone:

Cell Phone:

Class Selection

Classes denoted with an * require an audition or recommendation. If your desired class is not appearing below the class is full and closed to registration. Please make another selection or call 203-329-6676 to be placed on the waiting list.

Class:

Day:

Time:

Class:

Day:

Time:

Class:

Day:

Time:

Class:

Day:

Time:

Acknowledgment & Release

Registration is complete only after first payment is received.

I understand that dance activities have inherent risks of injury and, being fully aware of the risks, I consent to have my child participate in the programs and activities offered by Center Stage Dance Studio LLC. By signing, I declare that my dancer is in good health, and is able to physically participate in dance classes, rehearsals, performances and/or any and all Center Stage Dance Studio LLC activities. Further, I understand and acknowledge that because of the physical nature of dance, there may be physical contact for proper instruction and safety, between instructors and students during class. I hereby release Center Stage Dance Studio LLC from any and all liability and assume the risks of participating in the Center Stage Dance program. By signing, I accept my responsibility in paying tuition, registration fee and costume charges. I further acknowledge that I have read and agree to the Center Stage Dance Studio LLC Policies and Procedures, Tuition Schedule, and Dress Code, all of which are located on our website, www.centerstagedancestamford.com. By my signature below, I hereby give Center Stage Dance Studio LLC permission to photograph and/or video my child(ren) and consent to the use of material for advertising, marketing and promotional purposes.

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