Please fill out and mail in completed registration form with tuition and a $25 registration fee for new students.
You will receive an email confirming class placement.
Select Dance Academy & Performing Arts Center
Registration Form 2009/2010
Students Name: _______________________ Age:_______ Grade in the 2010/1011 School Year:___________
Birthday:___________________ School:_____________________________
Tell us about your past involvement in the performing arts.
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Parent's Name:_________________________________________________
Address: ___________________________________________________
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Day Phone: ________________ Evening Phone: ____________________
Cell: ______________________ Email:___________________________
Emergency Contact Name: _____________________________________
Emergency Contact Phone: _____________________________________
How did you hear about us? ______________________________________
Please indicate all dance classes and/or Acting classes for which you would like to enroll
Class Code: _____________________
Class Code: _____________________
Class Code:______________________
Please return this registration form and payment to:
Select Dance Academy & Performing Arts Center
5240 12th Ave East
Shakopee, MN 55379
In consideration of the opportunity to participate in the classes and programs of Select Dance Academy & Performing Arts Center, I release and discharge Select Dance Academy & Performing Arts Center, its Directors and Agents from any claims, demands, liabilities or damage arising from the participation of my child in any classes or programs sponsored by Select Dance Academy and Performing Arts Center. If the parents or Emergency Contacts cannot be reached in case of an emergency, consent is given for my child to receive medical or surgical care as recommended by the physician or hospital. I have also received and read a copy of the studio polices and will adhere to them.
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Parent/ Guardian Signature Date