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 _________ 4:00-5:00pm, Breakdancing, Ages 6-14
_______ 5:00-6:00pm Tap Level 2, Ages 11-15 _________ 4:30-5:30pm Tap, Level 2 Ages 7-12
_______ 6:00-7:00pm Tap Level 2, Teens/Adults _________ 6:00-7:00pm, Tap, Level 3, Adults
Tuesdays Fridays:
_______ 10:00-11:00am Tap Level 1 Adult _________ 3:30-4:30pm Tap Mommy/Daddy & Me, Ages 5-6
_______ 3:30-4:30pm Hip Hop Beginning, Ages 6-8 _________ 4:30-5:30pm MTW, Ages 10-16
_______ 5:30-6:30pm Jazz, Intermediate, Ages 9-15
_______ 4:30-5:30pm Hip Hop Beginning, Ages 8-12
________ 6:30-7:30pm Hip Hop, Beginning, Adults/Teens Saturdays:
_______ 10:00-11:30am Tap Performance Team, Ages 11-16
Wednesdays:
_______ 10:00-11:00pm Broadway Song & Dance, Adults
_______ 11:00-12:00am Tap Level 1, Senior
_______ 3:30-4:30pm Tap Level .5, Ages 6-8
____________ Class not listed, enter Title/Day/Time
____________ I would like my private slot from 2019 (Day: _____________, Time: _________________)
____________ I would like a new private slot as one becomes available (Day: _____________, Time: _________________)
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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