Halestone Summer Registration
Email address *
Participant First Name *
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Participant Preferred Name
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Participant Last Name *
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Participant Date of Birth *
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Participant Age *
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Parent/Guardian Full Name *
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Address *
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Phone Number *
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Email *
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Name of Emergency Contact *
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Phone Number for Emergency Contact *
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Liability Waiver: I verify that the student has been checked by a licensed physician and is physically able to participate in classes at Halestone Dance Studio. I understand that participation carries certain risks of injury and I assume all risks resulting from participation. I will hold harmless Halestone Dance Studio and their trustees, officers, employees, agents, and any and all affiliated departments from any and all liability, causes of action, claims and demands of every kind or nature whatsoever which may arise in connection with or resulting from participation in any Halestone Dance Studio classes or activities. *
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