*Student's Name
*DOB(mm/dd/yyyy)
*Street Address
*City
*State(XX)
*Zip
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*Home Phone (xxx-xxx-xxxx)
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| * Emergency Phone (xxx-xxx-xxxx) |
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| Cell Phone (xxx-xxx-xxxx) |
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| Work Phone (xxx-xxx-xxxx) |
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| *Email Address |
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| *Person Responsible for Payments |
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| Kindermusik |
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Village Feathers |
Dates/Time
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Village Do-Si-Do |
Dates/Time
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Our Time Wiggles & Giggles |
Dates/Time
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Our Time Away We Go! |
Dates/Time
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Imagine That |
Dates/Time
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| Music Program-someone will contact you with available times |
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Piano Lessons |
Tues & Wed/4-9pm Thurs/4-6pm |
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Clarinet Lessons |
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Beginning Voice Lessons |
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By submitting this form, I understand that there is potential for injury with participation in any sport, including classes at Katie’s Dance Studio; and, while at Katie’s Dance Studio, its owners, directors and teachers will make every reasonable effort to eliminate potential for injury, such injury may still occur. I understand this risk and agree to hold Katie’s Dance Studio, its owners, directors and teachers harmless from any and all liability connected with any injury arising out of participation in classes at Katie’s Dance Studio.
By submitting this form, I will abide by the policies and procedures described. I have read, understand and agree with the studio policies, procedures, fees and payment schedule.
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I have read and fully understand the above agreement. |
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