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Student Registration

Use this form to register your interest in an upcoming class. Please include an accurate telephone number; after you have submitted this form, we will contact you for payment information and to finalize your enrollment.

Items marked with an asterisk (*) are required.

Billing and Parent Information
First Name * Last Name *
Address *
City * State *     Zip *
Email *
Parent 1 Home Phone
Work Phone Cell Phone
Parent 2 Home Phone
Work Phone Cell Phone

Student Information
First Name * Last Name *
Address *
City * State *     Zip *
Email *
Birthdate Sex

Medical And Emergency Info
Medical Info
Doctor's Name Phone

Classes
Please select the appropriate level for Student or Adult division classes.
Class 1 Name Level Day
Class 2 Name Level Day
Class 3 Name Level Day
Class 4 Name Level Day
Class 5 Name Level Day
Class 6 Name Level Day
Class 7 Name Level Day

Agreement and Waiver

In Consideration of the dance lessons afforded for me under this agreement by Le Studio, Inc., and in recognition of the physically strenuous nature of dancing, I hereby knowingly, freely, and voluntarily waive any right of cause of action of any kind whatsoever arising as a result of activities from which any liability may or could accrue to Le Studio, Inc. or its agents.

I understand that the obligation to pay all fees described in the brochure/application is unconditional. No portion of this fee, paid or outstanding, is refunded in the event of absence, withdrawal, or dismissal of a student from the school.

I agree to pay all incidental expenses as incurred by this student which include, but are not limited to, costumes, dancewear, tickets, optional trips and special events, etc. Please note that late payment of tuition, fees, and any other expense is subject to a finance charge. I further agree to pay any reasonable costs, including attorney's fees, associated with the school's effort to collect funds due it under the terms of this contract.

I hereby give Le Studio permission to photograph/videotape the students for use in brochures, websites, and any other advertising media. I understand that said photographs and videos may be copyrighted in Le Studio's name.
I agree *
Full Name * Today's Date *