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Student's Name
*
Parent's Name(s)
*
Birth Year
*
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Birth Month
*
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Birth Day
*
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Gender
*
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*
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Home Phone #
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Indicates required field
How Did You Hear About Us?
*
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I am a...
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New Student
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Years Experience
*
Name of Previous Dance Studio
*
2019 Summer Programs
*
Princesses and Superheroes Camp
Under the Sea Camp
Flip Out! Acro Bootcamp
The Dance Experience Hip Hop
The Dance Experience Contemporary & Ballet
The Dance Experience Jazz, Tap & Musical Theater
Private Coaching Sessions
Medical Conditions/Allergies
*
I understand that mine or my child's spot is not held in their
Summer
program until the
full
payment has been made. I also understand that no refunds will be granted after June 15th.
I understand that mine or my child's spot is not held in their session program until the
full
payment has been made. I have also read the withdrawal policies.
I have read the Summer Registration Requirements
*
Yes
N/A
I have read the Session Registration Requirements
*
Yes
N/A
By checking this box I allow my child to dance at Pointflex Dance Company. I release the staff of Pointflex Dance Company of any liability in the event of an accident or illness during my child's class. I release photos of my child taken at Pointflex Dance Company or competitions and realize that they may be used for promotional material
I have read the Release of Liability
*
Yes
Signature Authorization (Full Name)
*
I agree to receiving marketing and promotional materials
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