2022-23 Dance Class Registration Form

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Thank you for choosing Laura Beglin Dance! To register for the 2022-23 dance season, please fill out all fields below, even if you are a returning student.

Email *

Parent/Guardian LAST Name *

Parent/Guardian FIRST Name *

RESPONSIBILITY WAIVER

Laura Beglin Dance will not be responsible for loss or damage or personal injury to you or your child or children during your visit to the studio. *

I have read and understood the above

Required

CONSENT TO PHOTOGRAPH/VIDEOTAPE/AUDIOTAPE/FILM INDIVIDUALS

Please note that, while the language of the photo/video consent declaration sounds very formal, in practice I will ALWAYS check with parents/guardians before using any image or likeness of your child or children.

I give Laura Beglin Dance permission to photograph, record video and audio, and/or interview the child/children named below, and to publish said photographs, video recordings, audio recordings, and/or interviews in Laura Beglin Dance publications/printed materials, including marketing and promotional materials, and the official Laura Beglin Dance website. The photographs, videos, etc. shall constitute the exclusive property of Laura Beglin Dance and may be reproduced by Laura Beglin Dance, without compensation or payment to the individual(s) concerned or any other person. *

I have read and understood the above

I have questions or concerns that I would like to discuss

Required

Primary Phone *

Primary Phone Type *

Mobile Phone (If Different from Primary Phone)

Emergency Contact *

Please indicate who to contact in the event of an emergency, along with their phone number(s).

Child 1 Name (First and Last) *

Child 1 Class Day/Time *

Child 1 Birthday *

YYYY

Child 1 Allergies/Medical Conditions? *

Please let me know if your child has any allergies or medical conditions you would like me to be aware of. If your child does not have allergies, please write "none."

Child 2 Name (First and Last)

Child 2 Class Day/Time

Child 2 Birthday

YYYY

Child 2 Allergies/Medical Conditions?

Please let me know if your child has any allergies or medical conditions you would like me to be aware of. If your child does not have allergies, please write "none."

Child 3 Name (First and Last)

Child 3 Class Day/Time

Child 3 Birthday

YYYY

Child 3 Allergies/Medical Conditions?

Please let me know if your child has any allergies or medical conditions you would like me to be aware of. If your child does not have allergies, please write "none."

A copy of your responses will be emailed to the address you provided.

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