Ann's Performing Arts Centre
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Fall Registration Form
Fall Liability Waiver
Student Information Form
Liability Waiver (PDF)
Credit Card Authorization Form
STAFF
POLICIES
Mesothelioma Cancer Alliance
CONTACT US
Fall Registration Form (2011-2012)
Dancer's Name
Street Address
City
Zip
Home Phone
Student's Cell Phone
Email
Birthdate
Age
Year Started with Ann
School Name
Grade in School
Dancer's Height
Dress Size
Street Shoe Size
STUDIO WILL COMPLETE THE FOLLOWING SECTION
Studio Use Only: Bust
Studio Use Only: Waist
Studio Use Only: Hips
Studio Use Only: Girth
Studio Use Only: Inseam
Studio Use Only: Outseam
PARENT/GUARDIAN INFORMATION
Name of Parent/Guardian/Person Dancer Lives With
Address (if different from above)
City (if different)
Zip (if different)
Home Phone
Work Phone
Cell Phone
Parent's Email Address
Yes, email me the monthly newsletter!
EMERGENCY CONTACT INFORMATION
Emergency Contact Name
Relationship
Select one....
Parent
Step-Parent
Grandparent
Sibling
Aunt/Uncle
Cousin
Friend of Family
Neighbor
Emergency Contact Phone Number(s)
ADDITIONAL INFORMATION
Names of other family members in dance
Please list any medical conditions the dancer has...
Student pickup instructions, if any
Please list any performance classes, if any
CLASSES & PAYMENT
List the classes you are registering for.
Annual enrollment fee is $25. Please select your payment method
I will call the studio with my credit card information.
I will bring payment to the studio during Open Enrollment.
I will mail my payment.
Open enrollment at the studio will be August 8-10.
Upon submission, you will be redirected to the Liability Waiver. Your registration is not complete without this form.
