Farmington School of Dance
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Please complete ONE form per child. Be sure to press
SUBMIT at the bottom of this page when you are finished.

*Indicates required response.

For Office Use Only

Custodial Care belongs to: *
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If you have taken at another studio, please select all the forms of dance you have studied.
How did you find out about us? (Check all that apply.) *
In case of medical emergency, I understand that when medically feasible, an effort will be made to contact a parent/guardian, but in the event one is not reached or it is not medically feasible to contact one, I hereby give permission for my child to be treated. In the event consent is needed for medical care on a non-emergency basis and I cannot be reached, Sue Savage is authorized to act on my behalf. Furthermore, I agree to hold harmless Farmington School of Dance and all of their employees and agents in the event of an injury occurring to my child during any activities associated with the Farmington School of Dance. I recognize that participating in this activity has a certain amount of risk and that an injury is always possible. I certify that my child is, to the best of my knowledge, physically able to participate in this activity. I assume full financial responsibility for medical expenses arising out of such injury.

I also allow all pictures and film taken of my minor child to be used for publicity purposes for the Farmington School of Dance. I hereby indemnify and hold harmless against any and all claims of damages arising out of taking or use of pictures or videos of my minor child.

I agree that my child and I will abide by the standards set by this studio in the parent handbook. By signing this registration form, I assume full financial responsibility for registration, tuition, costumes, recital and all other fees.

Submitting this form indicates that you understand you are responsible for the enrollment fee.
Your place cannot be held until the payment has been received.

Scroll down to the bottom of the page to submit this form.
All fields marked with * must be completed in order to submit.

By clicking submit, you are financially obligated to sending in the registration fee.

Please call or email with additional questions or to request a paper registration form.
Or return to our homepage for additional information.

Visitor since 8/12/2008

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