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HUDSON DANCE CENTER REGISTRATION FORM

Name of Student _____________________________DOB_________

#2 ___________________________DOB_________

#3 ___________________________DOB_______

E-Mail______________________________________________________

Full Address____________________________________________________

Mother’s Name_______________Father’s Name______________________

Home Phone # ______________ Mom/Dad-Cell Phone ________________

Emergency Contact-#_________________________________________

IMPORTANT: Is there any medical information the teacher should know about this student? Ie: asthma____________________________________________________

It is understood that with any physical activity, there is a risk of injury. I hereby release to the Hudson Dance Center, and all the instructors under its direction, from any liability toward potential injury that I/my child may suffer during the course of my/their involvement in a class or performance of any kind.
I also acknowledge that the instructors hold the right to dismiss a student from a class for justified reasons (i.e. distraction of class, lack of respect towards fellow dancers, non proper attire, etc.) Furthermore, if the problem persists, the Center reserves the right to dismiss the student indefinitely from the class or school without refund. I also acknowledge that the HDC cannot be held responsible for lost or stolen items. Students, teachers and all other employees from the Hudson dance Center are prohibited to copy, teach or share dance choreography’s, performances, etc., to the public or outside the HDC. All choreography’s, performances, etc., belong to the Hudson Dance Center and the Director.

Please note that all fees must be paid in FULL before the end of year show or the HDC reserves the right to dismiss the student from the performance.

There are no refunds after October 15th 2008. ___________ please initial

Signature:_________________________

*********************************************************

Class: #1__________________#2____________________

#3________________

PAYMENT: Cash $ ______________ Balance: $ _________

Cheque: $____________ Balance: $ _________

Payment plan: monthly amount of $ _______x 1 2 3 4 5 6 7

2009