This registration form is best printed out from the 2012-13 brochure but you may also print out this page.
Click here for more info on Registration Details and Class Placement questions.
You may print, fill out and send to us with your fee.
Please Note: Registration Confirmation is your deposited check and you will receive an email in August or beginning of September before classes start or after your registration if registering later.
Registration Form:
Name:______________________________
Age (by Sept. 1st) (DOB):__________________________
(Note: Minimum age by September 1st of the year is required especially for the younger (below age 7) classes).
Address:__________________________
__________________________________
__________________________________
Email(s) (for our monthly newsletter)
__________________________
Phone(s):______________________________
Emergency #:_______________________
Name & Relationship to Student______________
Please list any Special Needs, Allergies, Disabilities, Medications etc we should know about:________________
Classes / Times you are Registering for:
1._______________________/__________
2._______________________/__________
3._______________________/__________
(you may continue to add)
Dance experience, if any: (also list years at Reflections for Loyalty Discount)
__________________________________
__________________________________
Both Parents Names & Signature:
(MUST Print, Sign, & Date)
(signifies understanding of and adherence and agreement to all policies, Emergency Medical treatment if needed and release of all liability from “Reflections School of Dance Inc ” and it’s teachers)
____________________________________
Please include Non-Refundable $25 Registration Fee with form.
(+ $10 for each additional family member)
If you’re a new student also list below a name if anyone referred you.
Send to:
LEN & DEBBIE WIENS
Directors
13823 Seattle Hill Rd.
Snohomish, WA 98296
425-338-9056 (Ph.& Fax)
dance@reflectionsschoolofdance.com
www.reflectionsschoolofdance.com |
