Student Information
Name of Student
Audition #
Date of birth
Gender
Age
Grade
Home address
City
State
Zip code
Home telephone
Academic school
How did you hear about us?
Please list previous training, including schools and teachers.
Parent/Guardian One
Name of parent/guardian
Home address (if different from student)
City
State
Zip code
Home phone (if different from student)
Cell phone
Email
Parent/guardian two
Name of parent/guardian
Home address (if different from student)
City
State
Zip code
Home phone (if different from student)
Cell phone
Email
Waiver of Liability/Medical/Media Release/Agreement to Pay
I am aware that dance training places unusual stress on the body. On behalf of my child and myself, I assume the risk and agree that the CM Dance School, Board of Directors, Faculty and any of the chaperones and agents shall not be liable in any way for any injuries sustained or loss of property during attendance at the academy or any of its related functions. My child has permission to be treated for emergency medical care.
Medical insurance and number
Please share any information that will help us provide a safe and positive experience for your child while at CM Dance School, such as allergies, special medical conditions or learning disabilities.
I give my permission for photographs or television footage that include my child to be used for promotional purposes on television, newspapers, magazines, brochures, billboards or any other form of advertising.
A 4-month payment plan is available with an additional $30 fee and payments are due by the 1st of each month. Full payment is due by December 1 of the current calendar year.
There will be a $25 service charge for all checks received with insufficient funds. No refunds for any reason. In the case that we are required to close the Academy due to Corona Virus, classes will resume on ZOOM.
Electronic signature
Date
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