Quick Registration
Please fill out this form by February 8th for your dancer to be part of our June Production of Beauty and the Beast!
Email address *
Parent/Gaurdian First and Last name *
Your answer
Phone Number *
Your answer
Mailing Address *
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Student's Name *
Your answer
Students Birthday (Month/Day/Year) *
Your answer
Select the style of dance your student wishes to take in the 2018-2019 Season. *
Required
All students or legal guardians are required to read and sign the following statement. I, the undersigned, hereby release Revita Dance Studio, its agents and employees from all liability for personal injury, illness or property damage that occurs on or off premise used, rented leased or owned by Revita Dance Studio, whether or not caused by negligence of Revita Dance Studio, its agents or employees. I certify that I am / the child I am registering is in good health and capable of participating in all activities and classes. In an emergency I authorize Revita Dance Studio’s agents and employees to take temporary measures as deemed appropriate. I hereby give permission to Revita Dance Studio its employees and agents to take photographs and recordings of me/my child that will become permanent property of Revita Dance Studio. I consent to the use of such materials for promotional use and sale purposes by Revita Dance Studio. (Parent/Guardian Type Name) *
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