Spring 2018 Ballet Class Registration
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Child's First and Last Name
Child's Date of Birth
Parent's First and Last Name
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact's Relationship to the Child
Doctor's Phone Number
Waiver of Liability
I agree that I will not hold Connect the Dots School of Ballet or any faculty member liable for injuries sustained or illnesses contracted by my child while a student at Connect the Dots School of Ballet. If medical attention is required during class time, I understand that I will be contacted immediately. If I cannot be reached, I give my permission for an administrator of Connect the Dots School of Ballet to authorize treatment.
Class Day of the Week/Time
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