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ABSOLUTE DANCE STUDIO

1860 MELLWOOD AVE.  LOUISVILLE, KY 40206  502-896-4544

 

 

REGISTRATION FORM   ($30 Registration Fee Due @ Time of Registration)
 
 
1st Dancer Info:            
                                   
Name-            
Birth Date-                                      Age-            
School-                                          Grade-           
Address-            
City-                                                              
State-                Zip-            

Medical Conditions or Allergies-

 

2nd Dancer Info:            
                                   
Name-            
Birth Date-                                      Age-            
School-                                          Grade-           
Address-            
City-                                                              
State-                     Zip-            

Medical Conditions or Allergies-

 

Parent Name _______________________________ Phone # _______________Cell # ____________
Address _________________________________________ City ___________ State _____ Zip ______
E-mail Address _________________________________________________________
Emergency Contact _________________________________ Phone # _______________          
Cell #_____________
 
SIGN ME UP FOR THE FOLLOWING ABSOLUTE DANCE CLASSES!
 
Dancer: Class: Day: Time:
       
Dancer: Class: Day: Time:
       
Dancer: Class: Day: Time:
       
Dancer: Class: Day: Time:
       
Dancer: Class: Day: Time:
       
 
Permission to Participate and Photo/Video Release:
The undersigned as parent/guardian of the dancer(s) listed above hereby give permission for my child/children to voluntarily participate in
Absolute Dance,LLC. class, activities, and events.  I understand the inherent risk associated with these activities and that all rules/policies
imposed upon the participant(s) must be followed in order to reduce the risks or prevent injury.  In consideration for the advantages of my
child's/children's participation in the activities described above, I, for myself, my spouse, my heirs, and assigns, hereby release and hold
harmless the Absolute Dance, LLC, its present and future individual members, officers, agents, employees, directors, representatives and
insurers, from any and all liability, for bodily injury or property damages that may result from my child's- children's participation in the activities
described above except as provided by law.  I give permission for Absolute Dance! to use photos and/or video of the participant(s) listed above
for legal promotions.  Furthermore, I agree to carry health insurance on the participant(s) above for the duration of their participation in the above
activities.  

Insurance Company ______________________________________  Policy Number____________

Absolute Dance Studio Policies:
I have thoroughly read and understand the Absolute Dance "Dancer & Family Handbook", and agree that my dancer(s), family and guests will
abide by the policies set forth by Absolute Dance for the duration of their participation in the activities mentioned above. 

Parent/Guardian Signature ______________________________________________ Date____________
 
 
 
 

    

 
 
 
 
 

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