Registration Form

Dancer's Name *
Dancer's Name
Parent Phone Number *
Parent Phone Number
Dancer's Phone Number
Dancer's Phone Number
Dancer's Birthday *
Dancer's Birthday
Parent/Guardian Information
Name of the Person/Parent/Guardian Dancer Lives With *
Name of the Person/Parent/Guardian Dancer Lives With
Home Phone
Home Phone
Cell Phone
Cell Phone
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Additational Information
Classes and Payment
Annual enrollment fee of $25, Please select your method of payment. *
Dancer(s) Name *
Dancer(s) Name
Home Phone
Home Phone
Cell Phone *
Cell Phone
I will not hold Ann or David Buehler, the dance studios, or any staff member financially responsible for any accidents or injuries that may occur while my child(ren) is(are) on the premises at 1435 E Independence Suite 100 or at any special event that the studio may be attending. Dance is an active sport with inherent risks. This waiver of liability also includes any family or friends who may have temporary custodial care of the child(ren) listed above.By typing your name below, you are agreeing to the terms set forth in this Liability Waiver, giving full authorization with this electronic signature.
Today's Date *
Today's Date