2011-2012 RECREATIONAL REGISTRATION

* Required fields
Name *
E-mail Address *
Birthdate *
Age *
Years of Dance Completed *
Address *
City *
State *
Zip Code *
Home Phone Number *
School Attending *
Grade *
Class Time *
Mother's Name/Contact Numbers *
Father's Name/Contact Numbers *
Siblings at The Dance Studio (Names & Ages)
Name of Person Responsible for Payment on Account *
	I/we, on behalf of myself/ourselves and my/our minor child hereby release The Dance Studio, Inc., it’s officers, agents and employees and Northwestern College, from all claims for injury which may be sustained by my/our child while participating in dance classes, rehearsals, performances or other dance related activities.
Type full name for signature. This is your agreement for payment on your account and that you have read and understand the studio policies. *
Date *

I have read and agree to the Privacy Policy *

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You may submit your registration online or proceed with one of the following options:

E-mail Registration:

If you would like a registration form e-mailed to you please contact us at misskara5678@gmail.com

Send registration by mail:

The Dance Studio

PO BOX 49578

Blaine, MN 55449

Please note: You will not automatically be brought to the payment page after you've registered.