Child Registration Form

Welcome to the Davis Dance Room's Online Child Registration! To register, please fill out all contact information below. Once you submit this form you will be forwarded to the "Cart" where you can make the $25 registration payment and complete the sign up process. Your space for the requested class(es) is NOT reserved until payment is made.

    Student Information

    Name **
    Birthdate **
    School
    Grade
    Address
    City
    Zip Code
    Allergies

    Parent(s)/Guardians(s) Residing With Child

    Name:
    Relationship To Child
    Email **
    Cell Phone **
    Name:
    Relationship To Child
    Email
    Cell Phone

    All Persons Authorized To Pick Up Child

    Name:
    Relationship To Child
    Phone
    Name:
    Relationship To Child
    Phone
    Name:
    Relationship To Child
    Phone

    Which Classes are you interested in?

    Ballet
    Jazz
    Contemporary
    Hip Hop
    Creative Dance

    Additional Info

    How Did You Hear About Our Studio?

    Previous Dance Training (ie. number of years, technique studied, teachers, etc.)

    Required Policies and Agreements

    Tuition and Fees
    I agree that a non-refundable $25 Registration Fee is due at the time of registration and may be paid through our website using a debit/credit card (Square payments coming soon!).

    The monthly fee for one class a week is $40. Fees are reduced for additional classes per week or for more than one child per family. Once paid, tuition is non-refundable or non-transferable. If you decide to withdraw your dancer, you are responsible for logging on to your on-line portal and withdrawing your dancer prior to the beginning of a new month. This will cancel your tuition auto-pay.

    Privacy Statement
    I give permission to the staff of the Davis Dance Room to publish photos and/or videos in which my child appears for the purpose of education, promotion, or publication.

    Medical Eligibility
    I certify that the student seeking enrollment has recently undergone a medical examination and has been declared physically fit and able to participate in Dance activities by a licensed physician.

    Release of Liability
    I agree to adhere to all studio policies and rules of the Davis Dance Room LLC. In consideration of enrollment in these classes, I hereby waive release and discharge any and all claims for damages for personal injury, death and property damage, which may occur to me, my child(ren), family members, estate, heirs(s) or assigns (collectively "My Family"), as a result of participating in the course, practicing or performing instruction, and using the dance studio, any adjacent area, and any property owned or rented by Davis Dance Room, including all risk connected therewith, whether foreseen or unforeseen (collectively "Dance Activities"). I understand that serious accidents and injuries can occur during these activities, and I agree to indemnify Davis Dance Room against loss from any and all further claims, demands, and actions at law or in equity that may hereafter be brought by any member of My Family or anyone on his or her behalf for the purpose of enforcing a claim for damages on account of any injury or damage sustained during any Dance Activities.

    I Agree To All Of The Above

    Enter Your Full Name **