ADDRESS:_____________________CITY:_____________ZIP:___________

PHONE:_______________EMERGENCY #:___________________________

E-MAIL:________________________________________________________

DATE OF BIRTH:________________AGE:____________________________

SCHOOL ATTENDING:____________________________________________

MEDICAL CONDITIONS WE SHOULD BE AWARE OF_______________________________

I hereby agree not to hold SPINS DANCE STUDIO, its director, and staff responsible for any damages or liabilities due to theft, accident, or injury during or resulting from my child's participation in any capacity of or relating to any function or activity of the said SPINS DANCE STUDIO.  Payments for monthly classes and private lessons are due upon the first of the month.  There will be a 7 day grace period. Thereafter, a $15.00 late fee per month, will be applied to outstanding accounts.  I hereby assume all financial responsibility for above student(s) enrolled at SPINS DANCE STUDIO.  I further understand that I will be charged for all classes until I have notified the school of my or my child's withdrawl from classes.  In the event it becomes necessary to refer this account for collection, you (as the parent/guardian) will be reliable for all collection fees, including attorney fees, interest, etc. 

PARENT/GUARDIAN _____________________________________DATE:____________________