Student Registration
Student: _____________________ Parents/Guardian________________________________
Home#: ________________ Cell#:____________________
Email: ______________________________
Mailing address: ___________________________
____________________________
Date started at Stardust Dance: ___/___/_____
birthdate: ___/___/_____
in case of emergency,
contact: _____________________ ph # __________________
_____________________ ph # __________________
list any allergies: ______________________________
______________________________
special medical needs (if any): ______________________________
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______________________________
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Liability Waiver
I will not hold Stardust Dance or any of its associations accountable for any injury or accident that occurs in or around Stardust Dance, located 100F Oak Street, Maxwell, CA. I know that children are not to be left unattended at the studio unless within the hours of their appointed dance class. _____________ is here by the consent of his/her parent/guardian _____________.
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Signature Date
Policy
I have read and agree to comply with the policies set forth by Stardust Dance.
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Signature Date