| ** Students
Name: Last, First, Middle Initial: |
** Date
of Birth: |
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E-mail Address: |
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Age: |
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| Street Address (Apt. No.): |
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Home Phone: |
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| **Mailing
Address (P.O. Box) |
Cell Phone: |
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City:
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State |
**Zip
/ Post Code |
Fax Number: |
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| **Father's
Name: |
**Mother's
Name: |
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| Father's Place of Employment: |
Work Phone: |
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Mother's Employment: |
Work Phone: |
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Legal Guardian's Name:
(If Applicable) |
Place of Employment: |
Work Phone: |
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In case of emergency, in
the event you the parent or legal guardian
can not be reached, please list others for us to contact.
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| **Emergency
Contact #1 (Name): |
**Relationship
to Child:
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**Emergency
Contact #1 (Telephone or Cell Number): |
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| **Emergency
Contact #2 (Name): |
**Relationship
to Child:
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**Emergency
Contact #2 (Telephone or Cell Number): |
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| Emergency Contact #3 (Name): |
Relationship to Child:
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Emergency Contact #3 (Telephone or Cell Number): |
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Please list any dance, music or acting classes
your child has taken:
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SKIP POLICY
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| By submitting this on-line registration form,
I, the person submitting this on-line registration form as indicated,
state that I have understood and agree to the terms and conditions of
the SKIP POLICY as stated hereinafter. Participants must come to class
on time and be picked up on time. All students should be well groomed
and prepared for class. All classes must be paid for on the first class
day of each month. There will be a $5.00 late fee assessed on all accounts
that are not paid in full on the first class day of each month. In addition,
there will be a finance fee for all accounts that remain outstanding at
the end of each month, in the amount of 1.5% of the existing outstanding
balance. I further agree to pay any and all outstanding balances, immediately,
upon demand. |
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Required Information re: Person
submitting this On-line Registration Form
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| **Name: |
**E-mail
Address: |
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| **Relationship
to Dancer being Registered: |
**Telephone
Number: |
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Agreement
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| As an adult and /or parent and/or
legal guardian of the above registered student, I acknowledge, agree and
hereby authorize the adding of my e-mail address and the e-mail address
of the student being registered, if other than myself, to the SKIP Entertainment
News & Updates mailing list. I further acknowledge that I will have
the ability to subscribe to other SKIP mailing lists, if created, or "unsubscribe"
from the mailing list, should I decide to do so at a later date. |
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Wavier of Liability
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| As an adult and /or parent and/or
legal guardian of the above registered student, I certify (by submitting
this registration on-line) that I am the legal representative for the
above registered student, and on behalf of him/herself, executor, administrators,
or assigns, agree not to sue Children's Productions, Inc. (SKIP Entertainment
Dance Company) for personal injuries occurring to him/herself which may
arise out of any activities prior to, during or after the dance classes,
rehearsals or performances, or loss of or damage to personal property. |
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I acknowledge that
I have read and understand all information contained herein above. I
further acknowledge that I agree to all Policies, Agreements and Waivers
contained herein above and wish to continue and Register On-Line.
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I AGREE
(The above box must be checked before form can be submitted.
If you DO NOT AGREE then you may press
"Reset" and close the window.)
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