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Please print and mail this registration form, along with the

ONE TIME ONLY registration fee of $10 per family to:

Rhythm and Shoes Dance Studio c/o Jodi Endahl
   5300 South Robert Suite #200
   Inver Grove Heights, MN 55077

 

*this form works best in Internet Explorer - click here download the PDF version*

2007-2008 Registration Form
Student's Last Name First Name Date of Birth
     
     
Student's Last Name First Name Date of Birth
     
     
Student's Last Name First Name Date of Birth
     
 
                                              
Parent/Guardian Name ______________________________________________________________
     

Address:___________________________________________ City:______________________

Zip: __________
 
Home Phone:________________________ WorkPhone:___________________________
     

Emergency Contact and Phone:___________________________________________________
     
Email_______________________________   Email___________________________________
     
Previous Dance Experience (For Placement Purposes)
     
__________________________________________________________________________________
     
__________________________________________________________________________________
     
     
     
 

Waiver

  

Please read this form carefully and be aware in registering yourself and/or child for participation in this program you will be acknowledging the risk and releasing all claims which you may have or you may have on behalf of your child as a result of participating in this program.

Dancing is an activity in which, despite preparation, instruction, medical advice, conditioning and equipment, there is still a risk of injury.  As a participant or parent/guardian of a participant in the program, I acknowledge that there are certain risks of personal injury and I agree to voluntarily assume those risks and responsibilities which I, or my minor child, may sustain as a result of participating in any and all activities connected with or associated with such a program.

I release all claims which may arise against, and agree not to sue, Rhythm and Shoes Dance Studio and its employees and authorized volunteers from any and all claims by other parties resulting from physical or mental injuries, damages and losses caused by me or my minor child arising out of, connected with, or in any way associated with the activities of the program.

In the event of any emergency, I authorize Rhythm and Shoes officials to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my minor child’s immediate care.

I have read and fully understand the above.
Signature:   Date:
     
     
Class Start Time    
     
Class Start Date