Student Information

Student's Name *

Date of Birth *

School *

Family Information

Mother/Guardian Name *

Mailing Address *

City *

State *

Zip *

Primary Phone *

Other Phone

Your Email (required)

Father/Guardian Name

Mailing Address *

City *

State *

Zip *

Primary Phone *

Other Phone

Place of Employment (Father/Mother/Guardian) *

Emergency Contact *

Phone *

Emergency Contact

Phone

Care Instructions

Any Medical Conditions or Special Needs *

Who is allowed to pick up your child? *

Acknowledgment

Registration is not complete until Tuition fees are paid. This fee is not refundable.

By submitting the following form you agree to the following:

We, the parents of the student referred to in this submission form, fully understand the risks involved in acrobatics, tumbling, dance and exercise programs and will not hold Buddy Sherwood School of Dance, owner and its staff responsible for accident or injury jointly and separately, from all personal injury claims arising through or from participation in activities as a student of Buddy Sherwood School of Dance in or upon the premises of the named above studios/schools.

I agree to pay the monthly installment for myself or my child's classes on the first class of each month. If for any reason my check for classes should be returned to Buddy Sherwood School of Dance, I agree to pay a $40 returned check fee.

If I fail to pay the the 15th of the month I understand that I will be charged a $10 late fee on monthly tuition, costume fees and recital fees.

Buddy Sherwood School of Dance reserves the rights to refuse any of the studio services if the account is delinquent. Dance year is considered from August through May. These months are billed as full months.

For and in consideration of my child being allowed to participate in Buddy Sherwood School of Dance, I do hereby agree to allow Buddy Sherwood School of Dance to videotape and/or photograph my child in various Dance School activities. I hereby agree and consent to the release of my child’s likeness in videotape or photographs for commercial profit purposes by Buddy Sherwood School of Dance, including but not limited to the promotion of Buddy Sherwood School of Dance. It is also expressly understood and agreed that as one of the conditions of my child being allowed to participate in the annual recital, that no motion pictures or videotaping of any portion of the Dance Recital, will be permitted and that all aspects of the dance routines are the copyrighted property of Buddy Sherwood School of Dance.

I hereby certify that I have read, understand and acknowledge the payment agreement and the rules and regulations of Buddy Sherwood School of Dance.