Dancewave Fall 2017 Registration Form
Please complete one form for each student registering for Fall 2017 classes.
Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Student Date of Birth *
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Grade in 2017-2018 School Year *
Your answer
School *
Your answer
Student Gender *
Race/Ethnicity *
Student Mobile Phone
Your answer
Parent/Guardian Information
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent Occupation
Your answer
Address *
Please include city, state and zip code.
Your answer
How did you first hear about Dancewave? *
Emergency Contact Information
Name (Other than yourself) *
Your answer
Phone Number *
Your answer
Relationship to Student *
Liability Release
I give permission for my child to attend Dancewave classes during the Fall 2017 Semester (September - December 2017) at the following locations: Dancewave, Union Street Dance, Gallim Dance, and Old First Reformed Church. I HAVE READ AND AGREE TO THE POLICIES OUTLINED IN THE SCHOOL AT DANCEWAVE HANDBOOK. I agree to hold Dancewave, Inc., their agents, and all respective locations harmless against any injury, liability, or accident that takes place in rehearsals, classes, or performances administered by Dancewave. I understand that the Dancewave staff may, if deemed necessary for my child’s health, have my child hospitalized or use outside medical help without liability to Dancewave, Inc., or its class locations. I also understand that the staff may dismiss my child from the program if his/her conduct jeopardizes the safety of the entire group. *
Please initial below.
Your answer
Dancewave has a strict NO REFUNDS policy. Class credit only. All tuition includes a non-refundable $60 administration fee. *
Please initial below to accept this policy.
Your answer
Photo/Video Release
I consent to the use by Dancewave, Inc. of: *
Student Medical Information
Height *
Your answer
Weight *
Your answer
Allergies (If none, please write "none") *
If none, please write "none".
Your answer
Does your child take prescription medication regularly? *
If no, please write "no". If yes, please explain.
Your answer
Are there any psychological, learning and/or behavioral conditions that Dancewave should know about? *
If no, please write "no". If yes, please explain. This information helps us to best serve your child’s needs.
Your answer
Are there any access needs that Dancewave should know about? *
If no, please write "no". If yes, please explain. Example: Limited mobility, hearing impaired, etc. This information helps us to best serve your child's needs.
Your answer
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