2018/2019 Season On-Line Registration & Waiver
Name of Student
Your answer
Students Age
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Students Birth Date
MM
/
DD
/
YYYY
Please Select Class
Parent/Guardian Name (n/a for Senior Dance)
Your answer
Phone Number
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Email Address
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Mailing Address with Zip Code
Your answer
Are there any concerns the student has that the teacher should know about, i.e. health, developmental?
Your answer
By selecting "yes" below, I agree that neither Carolyn Stine McLaughlin or Movement Arts Atlanta (MAA) nor any of its employees, independent contractors, directors and/or officers will be held liable for any injury which may occur to my child while attending programing. I hereby release Carolyn Stine McLaughlin, MAA and their respective employees, independent contractors, directors and/or officers from any and all legal or financial claims. Also, I agree that images of my child taken during MAA programing can be used to document and promote MAA.
Name of Signator
Your answer
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