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Register Now!

 

To register for a class, print out the registration form below, fill it out and mail to:
Dance Fremont!
4015 Stone Way North
Seattle, WA 98103

Registration and Emergency Form

Dance Fremont!
4015 Stone Way North
Seattle, WA 98103

Are you a New _________ Returning _________ or Current _________ student?

Student's Name: __________________________Birthdate:_________________

Parent's Name:____________________________________________________

Address:________________________________________________________

City, State, Zip:____________________________________________________

Phone (H): _______________________(W)______________________________

E-mail Address:____________________________________________________

Where did you hear about Dance Fremont!:
________________________________________________________

Previous Dance Training: _____________________________________________

Desired Class(es), Time, Day: __________________________________________

Session:___________________________________________________________

I have read and understand the policies regarding non-refundable tuition, make-up
classes and payment obligations.

Signature: ________________________________________________________

Date:____________________________________________________________

Please check:
First Student's Tuition: ..................$ _____________________
Second Student's Tuition...............$ _____________________
Discount (If applicable) .................$ _____________________

Annual Registration (per family)............$ 25.00_________________

Total Payment Enclosed..........................$ _____________________

The Dance Fremont! faculty should be informed of any physical limitations (past injuries) or medical conditions that may require special attention for the student:

___________________________________________________________

___________________________________________________________

In the event of a minor injury (fall, scrape, strain, or sprain), the faculty of Dance Fremont! will apply ice, elevate and if necessary contact the parent or the contact person(s).

In the event of a medical emergency, the faculty of Dance Fremont! will call 911, and then will attempt to reach the parent or the emergency contact person(s).

Please list two people whom we may contact in the case of an emergency:

Emergency Contact #1________________________________________
Phone: ____________________________________________________

Emergency Contact #2 ________________________________________
Phone:_____________________________________________________

I have read and understand the emergency and non-emergency procedures mentioned above and agree to participate/allow my child to participate in the Dance Fremont! programs.

Signature:___________________________ Date:____________________


Thank you!