Intermediate Intensive Registration
Submit the following form to register a student (Ages 8 - 12) for Connecticut Dance School's Intermediate Summer Intensive June 26 - 28.
Tuition: $500
Email address *
Child's Name *
Your answer
Prefers to be called
Your answer
Birth Date *
MM
/
DD
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YYYY
Academic Grade Sept. 2019 *
Your answer
Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Email *
Your answer
Previous dance training?
Your answer
If new to our school, how did you hear about us?
Your answer
Injuries, Allergies, or Medical Conditions we should know about? *
Your answer
Physician's name and contact information
Your answer
Parent #1 Name
Your answer
Parent #1 Place of Work
Your answer
Parent #1 Work/Cell Number
Your answer
Parent #2 Name
Your answer
Parent #2 Place of Work
Your answer
Parent #2 Work/Cell Number
Your answer
Terms of Enrollment
1. Release of Liability: As the legal parent/guardian of the above named student, my signature below and the accompanying registration fee represent intent to enroll the above named student at the Connecticut Dance School. Furthermore, by signing this form, I release the school from liability for any and all injuries sustained during the course of dance or dance-related activities on the school’s premises or other venues where school sponsored activities may occur, except such injuries that may result from acts or omissions attributed to gross and intentional negligence on the part of the school, its employees, agents or principals.

2. Refund Policy: Registration fees are not refundable and Class Cards expire within twelve months of purchase. I accept the CDS policy of not refunding unused portions of tuitions or Class Cards, except in the case of severe, prolonged illness or injury that is verified by a physician’s certificate.

3. Photo/Video Release: I understand that photos and video footage may be taken of my child while in dance class or rehearsals at CDS. This may be used for publicity for the school in local newspapers, our website, Facebook and Instagram sites, and our brochures in keeping with the highest standards of CDS.
Acknowledgement of Terms *
Required
A copy of your responses will be emailed to the address you provided.
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