The Spokane Dance Center
Registration Form
1. Complete this form and mail to:
The Dance Center of Spokane
1407 E. 57th
Spokane, Wa. 99223
2. Please enclose the $10.00 Registration Fee and the first
session’s tuition.
3. Register by August 17th and get the
Registration Fee waived!!
CHILD’S NAME________________________________ BIRTHDATE_____________
PARENT’S NAME______________________________ PHONE_________________
ADDRESS______________________________ CITY_______________ STATE___
OTHER PHONE____________
EMAIL________________________
ZIP_________
1.COURSE TITLE_________________________ DAY__________ TIME_________
INSTRUCTOR_____________________________
1.COURSE TITLE_________________________ DAY__________ TIME_________
INSTRUCTOR_____________________________
NEW STUDENT?
YES___ NO___
REGISTRATION FEE
$__________
TUITION $__________
TOTAL ENCLOSED
$__________
LIABILITY/INDEMNITHY
AGREEMENT
I/We agree
to hold harmless The Dance Center of Spokane, its Employees and its Lessor from
any and all liability claims, actions, judgments, damages and injuries of any
kind and nature whatsoever to the participant and/or his/her property arising
from participation in activities for which the participant is registered. I/We
have familiarized myself/ourselves with the description of the activities,
understand the hazards, the participant’s personal limitations and knowingly
assume all risks.
Child’s
Name: ________________________________________
Parent’s
Signature: ________________________________________
