Adagio Dance Co.

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Enrollment Form

Please use the form below to register for classes with Adagio Dance Company. Note that fields with an asterisk (*) are required.

Student Name *

Address *

City *

State *

Zip *

Home Phone # *

Cell Phone #

Student Birth Date *

Student Age *

Parent/Guardian Name *

Parent/Guardian Email Address

Emergency Contact *

Emergency Phone # *

I understand that no credit will be given for classes unattended regardless of how many days are in any particular month. Make-up classes can be scheduled at the front desk. Tuition is due by the 1st day of the month for the entire month, any late accounts will subject to a $15.00 late fee. Service will be discontinued on any account that is 30 days past due.

I hereby give permission to Adagio Dance Co. to use any photographs or video of my child in order to promote our studio. All students and parent/guardian are aware of the possible physical injuries that may occur during any dance/gymnastics classes, performances and are willing to assume those risks. I agree and understand that Adagio Dance Co. is not held responsible for any personal injury or property loss.

Please list any Health or Medical conditions the studio should be aware of.

Any previous dance experience (such as styles of dance & number of years).

How did you hear about us? *

Please list your class choices

Class

Day/Time