ASHLAND SCHOOL OF DANCE

                                     ASHLAND SCHOOL OF DANCE           

                         REGISTRATION FORM

                                                              STUDENT INFORMATION

Name___________________________ Date of Birth_______Age_____

Previous Classes____________________________________________

Any Health or Physical Restrictions ASOD needs to be aware of?

                                                  PARENT/GUARDIAN INFORMATION
Name__________________________________________________
Address_________________________________________________
Home Phone___________________Work/Cell_____________________ 
E-mail_________________________________________________
Can we text you if classes are cancelled?  _________Yes  __________No

                                                                  IN CASE OF EMERGENCY
Contact_______________________________________________________
Home Phone___________________________Work/Cell___________________

                                                                     DESIRED CLASSES
 Class Name___________________ Days___________ Time____________
 Class Name___________________ Day­s___________ Time____________
 Class Name___________________ Day­s___________ Time____________
 Class Name___________________ Day­s___________ Time____________

Monthly/Semester/Yearly Rate____________ Cash_________ Check#_________

 I (we) have read and understand the ASOD 2017 Dance Season Program information and studio policies. I understand that participation in this dance program is voluntary and strenuous, and verify that I and/or my child are physically fit to participate. I waive and release Ashland School of Dance, Instructors, their heirs and their assigns from any and all rights and claims for injuries suffered or medical expenses which may occur as a result in the participation in this dance program.

Parent/Guardian Signature_______________________Date__________

                                                               PHOTOGRAPHY RELEASE
I hereby grant absolute right and permission to the Ashland School of Dance to use photographic portraits of my child for illustration, promotion, or advertising purposes. I have read and agree to the above statement.   ____Yes   ____No

Make checks payable to: Ashland School of Dance
All questions regarding tuition and registration should be directed to and registration form sent to: ASOD  1310 Vaughn Ave Ashland, WI 54806   715-292-3567