REGISTRATION FEE (Required*)

Name: REGISTRATION FEE (Required*) — Ms. K's Dance Academy
Brand: Ms. K's Dance Academy
Availability: InStock

REGISTRATION FEE (Required*)

from $75.00

Registration Fee Required For Every Student.

Please Select Your Student Registration Level I.E ( Basic, Loop Squad, or Swagga Jumpers)

Then Click (Add To Check Out) Button Below.

Registration Level:

Regular $30.00 Loop Squad $50 Swagga Jumpers $50

Quantity:

( ADD TO CHECK OUT )

Ms. K's Dance Academy Student Registration Form

One Application Fee Per HOUSEHOLD.

(Multiple participants must reside in the same household)

All applications must be submitted by a Guardian Ages 18 or older!!!!

How Did You Hear about Ms. K's Dance Academy? (Optional)

Student 1 Information (Required)

Student Name

First Name

Last Name

Student D.O.B

YYYY

Student Enrolled Class Choice(s)

Please select at least 1 class to enroll your student in.

Student Enrolled Class 1

Student Enrolled Class 2

Student Enrolled Class 3

Student Enrolled Class 4

Student Enrolled Class 5

Student Enrolled Class 6

Student 2 Information (Optional)

Student (2) Name

First Name

Last Name

Student (2) D.O.B

YYYY

Student (2) Enrolled Class Choices(s)

Please Select at least 1 cast to enroll your student in

Student (2) Enrolled Class 1

Student (2) Enrolled Class 2

Student (2) Enrolled Class 3

Student (2) Enrolled Class 4

Student (2) Enrolled Class 5

Student (2) Enrolled Class 6

Please Select Your Desired Studio Location

Please Select Your Desired Start Date

When would the enrolled student Like to begin

YYYY

Parent's/Legal Guardian's Information

Parent Name 1

First Name

Last Name

Parent Name 2 (Optional)

First Name

Last Name

Street Address

Please provide current residence

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone #

(###)

###

####

Work Phone # (Optional)

(###)

###

####

Email Address

Emergency Contact

(Other than Parent)

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone #

(###)

###

####

Important Information

IN CASE OF MEDICAL EMERGENCY

The undersigned gives permission to Ms.K’s Dance Academy, owners, teachers, coaches, Instructors & operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician or Hospital be contacted.

Doctor/Physician/ Hospital Name

First Name

Last Name

Doctor/Physician/ Hospital Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the student have any ailments, allergies or restrictions? Yes Or No

Yes

If you selected yes above, please explain:

PLEASE READ POLICY BELOW BEFORE SUBMITTING!!!

(Release of Liability) As the legal parent or guardian, I release and hold harmless Ms.K’s Dance Academy & Double Dutch training, its owners and operators from any and all liability, claims, demands, and causes of action what so ever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or that of any premises under the control and supervision of Ms.K’s Dance Academy/ Double Dutch training, its owners and operators or in route to or from any of said premises. Payment and Tuition Information) I do understand that tuition is due on the 1st Saturday of each month and a $25 late fee will be added on if payment is made any time after. There are no refunds under any circumstances. Once a down payment is put on a costume it is ordered. If there is any tuition issues please feel free to contact Ms.K Please Note We respect your privacy.

I've read and filled out all of the above, and have read Studio Policies located above and agree.

Signature of parent or legal guardian, if student is under age 18.