Registration

City State Zip *

Student First Name: *

Home Street Address:

How did you hear about us?

I, the parent listed in "Full Name" of the Parent Information section above, do hereby agree to give my child(ren) or ward(s) permission to participate in the programs and classes offered by the Next Step Dance Studio, LLC. Each student may decline to participate in any activity. Please inform the director of The Next Step Dance Studio regarding any physical limitations your child might have. I hereby release and hold harmless The Next Step Dance Studio, its owner, teachers, assistant teachers, or any other representative of The Next Step Dance Studio from any and all claims for damages or personal injuries, including accidental death, COVID-19, which I or my child(ren) may sustain while participating in any activity directory or indirectly connected with The Next Step Dance Studio. If a parent or guardian cannot be reached in an emergency, I hereby consent to the treatment of my minor child/ward for any medical procedures deemed necessary as a result of an accident or injury. I agree to pay any and all costs incurred as a result of said treatment. The Next Step Dance Studio does not carry medical insurance for its students. It is required that all dance students be covered by their own family medical insurance policy. If any injury occurs, it is understood that the students' own policy is the only source of reimbursement. I also hereby give permission for my child to be photographed or videotaped to be used for any promotional materials or advertisements. PLEASE FULLY READ AND UNDERSTAND THE STATEMENT ABOVE BEFORE CHECKING BELOW *

I have read and fully understand the statement above and voluntarily assume all risks related to and associated with attending classes as stated above

Parent or Guardian: *

Parent / Guardian Signature:

Additional information: (Creative Move/Combo day preferences)

Phone *

Email: *

Date:

Age: *

Student Last Name *

Birthday: *