Dance Studio in Brewster New York

Taps-N-Toes - ONLINE REGISTRATION -

* = Reqired Input       Please read our WAIVER before continuing.

  Location

* Student Name

* Address 1

  Address 2

* City State:   * Zip

* School

* Grade:

  Birthdate * Age:

* Dance
  Experience

Home Phone#

Email Address

Desired Courses Refer to Ballet, Tap, Jazz, etc. RE: Check schedule for course availability. Please type in the course in the box below.

   Day & Time

   Day & Time

   Day & Time

  Mother's Name

  Place of Work

  Phone (h)
Work#

  Father's Name

  Place of Work

  Phone (h) Work#

Intended
method of
payment:
If you select Check, make it
payable to: Tap-n-toes, Inc.
You are not registered until payment is received.
Thank you for your business! Amount: $

Terms
AGREEMENT TO PARTICIPATE AND LIABLITIY WAVIER: I understand dance and related activities involve risk of injury. I agree I will not hold Taps-N-Toes, Inc., (it’s owners, staff or related parties) responsible for injuries/damages incurred by any of my family members while participating or visiting facilities. AUTHORIZATION OF MEDICAL CARE: In case of injury or illness while participating, I authorize medical care for my child and accept responsibility for medical expenses. POLICIES AGREEMENT: I have read, understand and will abide the policies set forth by Tap-N-Toes, Inc., including no refunds on tuition or costumes paid.

* Electric signature box - Please type in your name.

* I have read and agree to the above terms.

Location
* Student Name
* Address 1
Address 2
* City			State: * Zip

* School
* Grade:
Birthdate	* Age:
* Dance Experience
Home Phone#
Email Address

Desired Courses	Refer to Ballet, Tap, Jazz, etc. RE: Check schedule for course availability. Please type in the course in the box below.
		Day & Time
		Day & Time
		Day & Time

Mother's Name
Place of Work
Phone (h)		Work#
Father's Name
Place of Work
Phone (h)		Work#

Intended method of payment:	If you select Check, make it payable to: Tap-n-toes, Inc. You are not registered until payment is received. Thank you for your business!	Amount: $

Terms	AGREEMENT TO PARTICIPATE AND LIABLITIY WAVIER: I understand dance and related activities involve risk of injury. I agree I will not hold Taps-N-Toes, Inc., (it’s owners, staff or related parties) responsible for injuries/damages incurred by any of my family members while participating or visiting facilities. AUTHORIZATION OF MEDICAL CARE: In case of injury or illness while participating, I authorize medical care for my child and accept responsibility for medical expenses. POLICIES AGREEMENT: I have read, understand and will abide the policies set forth by Tap-N-Toes, Inc., including no refunds on tuition or costumes paid. * Electric signature box - Please type in your name.
	* I have read and agree to the above terms.