Form Page: Registration

Studio D, Dedicated to Dance

27 Main St., Suite D
New Milford, CT 06776
ph: 860-350-2900
studiodllc@aol.com
www.dancestudiod.com

One form per student

Student's First Name

Student's DOB

Student's Last Name

Parent's Last Name

Parent's First Name

Mother's Cell

Mother's Work

Address

Home Phone

City

Father's Cell

Zip Code

State

Father's Work

Email address

Contact Information

Relationship

Last Name

Phone Number

First Name

Emergency Contact Information

Allergies/Medical conditions

How did you hear about us?

Grade entering into

Student's email address:

Student's phone number:

Additional information

I agree that Studio D may use photographs and videos of my enrolled dance student for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I, parent/guardian of the above named student verify that my child is in good health for participation in requested classes and that all information on form is correct. I will not hold Studio D or any faculty/staff liable for injuries on property or illness contracted by my child or myself while enrolled in classes.

Liability Agreement

Photo Release

Class1

Monthly

Quarterly

Yearly

I have read, understood, and agree to the policies of Studio D.

Class5

Class2

Class6

Class3

Class7

Class4

Class8

Class Selection

Please provide us with your choice of tuition payment:

Payment Method