Student Information:
(Please print and fill out a form for each student)

Dancer’s Name: ____________________________________ Phone: _____________________

Address: ______________________________________________________________________

City: _______________________ Zip: ____________ Parent E-mail: _____________________

Date of Birth: _______________________________________________Age:_______________

Health problems or physical limitations? (Ex…Asthma, Allergies, Emotional, etc…):

______________________________________________________________________________

______________________________________________________________________________

Please list the custodial parent(s)/legal guardian(s) below:

Parent(s) Name: ______________________________________ Cell Phone: ________________

Emergency Contact: _______________________________ Phone Number: ________________

• My child has no existing health problems unless listed above.
• Studio 31 Dance Center, Inc. and its employees cannot be held responsible for any

losses of personal property or valuables.  Any clothing, shoes, toys, or jewelry left at

• the studio will be placed in the lost and found.  Anything left more than thirty (30)

days will be given to charity. 

• Siblings of dancers should not be left unattended.  Studio 31 Dance Center, Inc. and its

employees are not responsible for any unattended children. 

• I give my permission to use images of my child captured during regular and special class time   as well as any performances, for the purpose of studio flyers, publications and the studio website.  I understand that my child’s name will not be stated with the photo.

Studio 31 Dance Center, Inc., including all owners, all employees, and teachers are not liable for any claims for damages or injuries of any kind, nature or description, resulting from any activities on the premises by any member of my family.  This expressly includes but in not limited to, any injury or damage caused by or resulting from the negligence of Studio 31 Dance Center, Inc., all owners, all employees, and teachers.  I acknowledge the fact that certain types of injuries are common and inherent in dance and tumbling related activities. 

Your signature below states that you have read all studio policies and agree to them.

________________________________________________________________________

Parent/Guardian Signature                                                                                                                 Date