AUSTIN DANCE ARTS REGISTRATION FORM  Owner/Instructor: Deidre Russell Robinson Click Here for Printable PDF Format Student's name:____________________________________________________________ (Last) (First) Age:______Years    Grade:_____    Birth date: Month____________ Day______ Year_____   Parent or Guardian's name:___________________________________________________ (Last) (First) Mailing address:___________________________________________________________ Home phone number:______________________ Emergency contact:________________________    (other than parents) Mother's employment:______________________   Father's employment:_______________________ Doctor's name:____________________________ E-Mail:__________________________ Phone:__________________________ Phone:__________________________ Phone:__________________________ Phone:__________________________   Medical information and/or allergies in relation to physical activity for your child: _________________________________________________________________________   Previous dance experience:_______________________ Years:_________ Where:_______ Please read carefully and sign below to complete enrollment: In consideration of the benefits of instruction provided by Austin Dance Arts for my child, I intending to be legally bound, do hereby enroll my child named above in the program, and do hereby waive claim and release finally Austin Dance Arts and Deidre Russell Robinson, for claim or liability for any injury or accident occurring on or arising from the instructional program or incidental sponsored activities, either on or off of the premises, where instruction is provided. I do authorize emergency first aid care to said student by Austin Dance Arts in the event he/she becomes injured or ill during the instructional program. If the parents and/or guardians of the child are not immediately available at the telephone numbers provided in this agreement, I further authorize Austin Dance Arts or such agents as may be authorized by Austin Dance Arts to retain the services of a physician or other competent emergency medical persons to treat the said minor; and I do accept full financial responsibility for any charges arising from such treatment.   Parent's (or guardian's) signature:____________________________Date:_____________   Classes enrolled:___________________________________________________________   Day(s):________________________________ Times:_____________________________   Total hours enrolled per week:_________________________Monthly tuition: $__________   ______ (initial) I give Austin Dance Arts permission to film or photograph my child for promotional or educational purposes.   Home     Class Summary & Dress Code      Schedule     Tuition Rates     Calendar