• Tell me about yourself...

  Parent or Guardian's Name
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Cell Phone
  Work Phone
  Home Phone
  E-mail

• Tell Me about your child...

  Student's Name
  Years of Dance
  Types of Dance Taken
  Date of Birth
  Sex	Male Female

• Please specify the specific classes that you'd like to enroll in or have more information about.. We will do our best to fulfill your requests however class placement can not be guaranteed until you get a notification back from the studio director.

  Release Form:

  As with any form of physical activity, there is the possibility for injury.  The Dance Works and its agents do not assume responsibility for injury.  The undersigned agrees to not hold The Dance Works or its representatives liable for injury and further assumes financial responsibility for any medical attention from participating in the above classes or while on The Dance Works property.

Date ___________________      Signature______________________________________

______________________(Please initial after reading the following)  The Dance Works occasionally uses photos of students on the web, and/or advertising purposes.  The Dance Works has my permission to use any dance pictures taken of the above named student.