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DANCING LIGHTS REGISTRATION
SUMMER 2009 - due immediately
FALL 2009-2010 - Due by August 1, 2009
DANCERS NAME: ______________________________ CLASS LEVEL: ___________
DAY: __________________
ADDRESS: ______________________________ TIME: _________________
______________________________ LOCATION: circle one
HOME PHONE: ______________________________ Dancing Lights Middletown
Green Acres Pre School
DATE-OF-BIRTH: _______________ AGE: __________ TLK Middletown
TLK Smyrna
ALLERGY INFO: ______________________________
□ Return Dancer □ New Dancer: Previous years experience? _________
Parents Names: Mom _________________ Dad __________________
Work Number: Mom _________________ Dad __________________
Cell Phone: Mom _________________ Dad __________________
Email Address Required: ______________________________
Emergency Contact: _________________________
Relationship: _________________________
Phone Numbers: __________ home _________cell _________work
Please be sure to pay your tuition and registration fees accordingly! They are needed in order for us to properly register you for classes.
WAIVER AND RELEASE
DANCERS NAMES: _________________________________
I understand that DancingLightsBalletSchool may from time to time take photographs and/or video of the dancers enrolled on this form. I, the parent/guardian do/do not authorize Dancing Lights to use such photographs and/or video for archival and publicity purposes. IN WITNESS WHEREOF, I have read and understand this waiver.
Signature: _________________________ Date: _______________________
Parent/Legal Guardian
Return forms to: Dancing LightsBalletSchool, P.O. Box 63, Odessa, DE 19730
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