AATT ACADEMY SUMMER PROGRAM
5 WEEK PROGRAM: JULY 16th - AUGUST 15th

FULL PROGRAM break down:
JULY 16th to AUGUST 15th TUES - THURS from 8:30 AM - 2 PM
COST: $100 (75 classes)

REGISTRATION FORM 2019
Parent/ Guardian's name:
Your answer
Address:
Your answer
Parent/Guardian's phone number:
Your answer
Email:
Your answer
Student's name:
Your answer
Birthdate:
Your answer
Student's age:
Your answer
What school does the student attend?
Your answer
Grade:
Your answer
Has the student ever studied dance?
MEDICAL AND EMERGENCY INFORMATION
Emergency contacts. Please provide two (2) contacts:
Name:
Your answer
Relationship
Your answer
Phone number(s):
Your answer
Name:
Your answer
Relationship:
Your answer
Phone number(s):
Your answer
Please list ALL food allergies, previous injuries, disabilities, medical conditions (e.g. asthma), IEP/ learning ability:
Your answer
In the event that my student experience(s) a medical emergency, I give BAAD! and it's representatives permission to call 911:
Medical insurance information:
Name on Card:
Your answer
Policy Number:
Your answer
I agree to hold harmless BAAD! and their employees in case of accident or injury.
Names of people who are allowed to pick up student:
Name:
Your answer
Relationship
Your answer
Phone number(s):
Your answer
Name:
Your answer
Relationship
Your answer
Phone number(s):
Your answer
I agree that I or my designee will pick up my student promptly after every session.
PHOTO/VIDEO RELEASE
I hereby authorize BAAD! and anyone else BAAD! assigns to photograph and/or video my student for the purpose of promoting AATT Academy on all media outlets, including social media.
PAYMENT INFORMATION
AATT ACADEMY tuition is $100.00 for the full program. Registration deposit: $30 (included in tuition). Full payment is due by Parent Orientation on Friday July, 12th. Scholarships available. Payment may be made via cash, credit card, checks or money order.
PLEASE FILL OUT ENTIRE FORM
Cynthia Paniagua
Dance Education Coordinator
BAAD! Bronx Academy of Arts and Dance
2474 Westchester Ave.
Bronx, NY 10461
718.918.2110

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