Please PRINT and bring in this form for registration

Dance Trenton

Registration Form 2010-2011

(Please Print)

Child’s Name: ________________     Class Type       Day      Time                             Office Use Only   

                                                                                                                                                                                Sept. _________

Address________________________         Course #1 ____________________________            Oct. _________

                                                                                                                                                                                Nov. _________

City/State/Zip ___________________          Course #2 ___________________________                              Dec. __________

                                                                                                                                                                                Jan. __________

Phone # _________________________      Course #3 ____________________________            Feb. __________

                                                                                                                                                                                Mar. __________

Male___ Female ____Age ____ Grade ____ Course #4 _____________________________         Apr. __________

                                                                                                                                                                                May __________

Birthday: _____________                                                                Office Use Only                                                    June __________

                                                                                                Date Paid: _________

                                                                                                Cash _____ Check ______ Cr. Card ______

Email: ______________________                                

                                                                                                Receipt # _____________                  Course Fee ________

Waiver for Participation

In consideration of your acceptance of my child’s registration in this program, I do hereby, for myself, my child, my heirs, and personal representatives, waive release and forever discharge any and all rights and claims, for damages which I, or my child may have or which hereafter accrue to me or my child against all municipalities, school districts, and properties through which the program will be held on and its or their respective officers, instructors, administrators, successors, and/or assigns for any and all damages which may be sustained or suffered by me or my child in connection with said association with this program and my or my child’s participation therein.  I further represent that I and my child are in good physical condition and have no disability or ailment that will prevent me or my child from engaging in the activity for which I or my child is registered.

Signature: ____________________________            Date: ____________________

In case of emergency call: _______________________          Phone: ________________

You are pre-registered for these classes.  You must register by Monday, August 24^th or Wednesday, August 26^th between 5:00pm and 9:00pm to keep your place in class.  Payment is due for the first semester at this time.  If you need an alternate payment method, please see Ms. Gina.  Remember: During registration, shoe fitting and dance apparel will be available.  Classes resume on September 22^nd, 2009.