Dance Registration Form
Please be Advised the following programs are now full- Ages 5-7 Hip Hop and Preschool Dance Saturday 10am
Email address *
Name of Student *
Date of Birth *
Medical Number and PIN *
Please list any allergies or medical condition regarding your child
Cell Phone Number *
Home Phone Number
Emergency Contact Name and Number *
Class name(s) and age category
Is your child enrolling in...
How will you be making payment? Payment can be mailed to Box 130, Carberry or dropped off in person at Municipal office of our office at 122 Main street
Please note! Cancellations of classes must be made one week prior to state date. The Carberry Plains Arts Council will no give refunds after the first day of classes has begun. The Carberry Plains Arts Council is not responsible for replacing any lost, stolen, or damaged personal items during Arts affiliated class. *
Medical Consent: I give the certified staff, volunteers and class instructors of the Carberry Plains Arts Council permission to administer First Aide/CPR to the student named above in the case of a Medical Emergency *
Photo Consent: The Carberry Plains Arts Council would like your permission to use images/photos that may include yourself and/or your child on our website, social media page, newspaper, local media, flyers or print materials for marketing purposes and local talent recognition.
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