2023/24 Single Dancer Pass Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dancer's Name & Age: *

E-mail Address: *

Home Address: *

Phone Number: *

Additional Emergency Contact & Phone # *

Please list your dancer's 6 classes below: *

Please list any additional classes ($100/class)

Total amount due (flat rate of $2640 + any additional classes + $25 registration fee) *

If paying in 3 installments, 3 payments of: *

Paid via: *

Venmo (HeyMeg_Funk)

Cash

Check

Please initial below, to state you understand and agree to the following: I understand that there are no refunds or credits. And, that regardless of class changes we make, we will owe the amount above for this dance year. *

Please initial below, to state you understand and agree to the following: I understand that the risk of physical injury, and illness, is inherent with group settings and dance training . I do not hold Margaret Fenton Funk, or Nutmeg's Dance & Theatre Co., responsible for any injuries, losses or death. I, the undersigned, am willing to assume those risks and release, hold harmless, and indemnify Nutmeg's Dance & Theatre Co. and all it's instructors from and against any and all claims, demands, actions, or judgements which I, or any other person, ever had or have against Nutmeg's Dance & Theatre Co. for any losses, costs, and expenses (including attorney's fees) and damages or injuries known or unknown, real or personal, sustained by me or my child while in attendance or participating in all Nutmeg's Dance & Theatre Co. programs. I, the undersigned, also agree that I will not hold Nutmeg's Dance & Theatre Co. responsible for the loss or damage of personal property while in attendance or participating in any of the Nutmeg's Dance & Theatre Co. programs. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms