Dancer Name : _________________________________________DOB: _________Entering Grade________

Mailing Address : _________________________________________________________________________

City: __________________________________________________________ Zip : _____________________

Email address to receive studio communications:________________________________________________

Parent/Guardian : ­­­­­­­­­­­­­­­_________________________________________________________________________

Home Phone : ________________________________ Cell : _______________________________________

Emergency Contact : _______________________________________________________________________

Relationship to Dancer(s) : __________________________________________________________________

Phone # : ________________________________________ 2^nd :___________________________________

Physician’s Name : __________________________________Phone # : ______________________________

Insurance Company : _________________________________Phone # : _____________________________

Please list any allergies, medical conditions, or restrictions: ________________________________________

________________________________________________________________________________________

Read, Initial and Sign Below

________Waiver of Injury: I, the undersigned, do hereby voluntarily submit my child for attendance and full participation in the N-Step Dance Center Program.  I, the undersigned, do hereby waive all claims against the instructors, owners and/or operators, individually or otherwise, of N-Step Dance Center for any injuries she/he may sustain while participating in said programs. I fully understand that any medical treatment given to my child will be first aid only, however I give emergency treatment authorization if I cannot be reached. This form can be photocopied for emergency treatment.

________Cancellation Policy: I, the undersigned, do understand that if at any point I terminate enrollment at N-Step Dance Center, I need to submit a written notice 30 days before cancellation. I also understand that I am responsible for tuition up to the last day of enrollment. If I do not submit a 30 day notice I am still responsible for tuition until one is given and/or the 30 days is up.

________I understand that any missed classes are my responsibility and are non-refundable (this includes, but is not limited to illness, vacation, other extracurricular activities, etc).  I understand that these classes may be made up in a similar class during the week.

By Signing below I agree to all of the Policies set forth by N-Step Dance Center.

Parent/Guardian : ________________________________________ Date : _____________________