Enrollment Form

 

Name: __________________________________________________                 email (Please print clearly)_______________________________

 ______    Return          Address __________________________                                  Phone Number ________________________________

               Student

City:    ________________________________  State ______  Zip Code ________          Phone Number ___________________________

 

If above student is a child, please list parents or guardians below.                Cell Phone Number _______________________

Parent/Guardian: ________________________________________________                  Birthday (mo/day/year) ___________________  

                                                                                                                                    Emergency Phone Number ______________________

 

Please select the classes you are registering for from the list below.  

Mondays:                                                                                                Thursdays:

 _______   3:30-4:30 Tap Level Beginning, Ages 5-6                              _________ 11:00-12:00pm Tap, Level 1, Adults

_________ 4:30-5:30pm, Breakdancing, Ages 6-14                               _________  4:30-5:30pm  Tap, Level 2 Ages 13-16

 _______   6:00-7:00pm Tap Level 2, Teens/Adults                                _________  6:00-7:00pm, Tap, Level 3, Adults

                                                                                                                     

Tuesdays                                                                                                   Fridays: 

 _______  11:00-12:00am Tap Level Beginning  Adults                        _________  3:30-4:30pm Tap Mommy/Daddy & Me, Ages 5-6

                                                                                                                    _________  4:30-5:30pm  MTW, Ages 10-16

  Wednesdays:             

   _______ 11:00-12:00pm Broadway Song & Dance, Adults               Saturdays: 

   _______ 5:15-6:15pm Tap Level 2 Ages 10-14                                     ______ 10:00-11:30am Tap Performance Team, Ages 12-18

                                                           

                                                                 

                   

                      

   

____________  Class not listed, enter Title/Day/Time

____________  I would like my private slot from 2021 (Day: _____________, Time: _________________)                      

____________  I would like a new private slot as one becomes available  (Day: _____________, Time: _________________)

 

_______________________________________________________________________________________________________________________________

WAIVER OF LIABILITY                

                                                                                                                                                                                                            Date:  __________________________________

 

                            I/we, the student and/or parent(s) or legal guardian(s) of (student name): ______________________________________ _______________________________,a minor student, at Dance With Sherry Studio, agree to absolve, release and hold harmless Dance With Sherry Studio and/or its’ instructors, or other adult chaperones from any financial liability or claim for damages of any nature arising out of any event associated with the studio.  We realize that any event has certain risks involved and that every attempt will be made to safeguard students and belongings, but that no amount of precaution taken by the instructors can guarantee safety.

 

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                                                                                                                                                         Signed By

 

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