Name_________________________________________________________________________________________________

Address________________________________________________________________________________________________

City______________________________________________________________State_______________Zip_______________

Phone: home____________________________________________work ____________________________________________

If under 18 yrs:

Parent's name____________________________________________________________________________________________

Birthdate________________________

Class	Session	Days	Times	Tuition
Total Tuition
Amount Paid

Tuition is due in full at the beginning of each session, unless other arrangements have been made.

Liability Disclaimer:
Neither New Dance Studio nor its instructors are liable for personal injury or loss of or damage to personal property. Dance is a physical activity and injuries may occur. The person (or parent of a child) taking a dance class is responsible to inform the faculty of any physical limitations which prevent full participation in a dance class and is also responsible to appropriately decline from any dance activity that may be harmful.

Please sign below after reading the disclaimer:

Signature____________________________________________________________________________ Date___________________

(This disclaimer must be signed before the first class, or participation will not be allowed)

Print out this form and send to:

New Dance Studio, 61 Pleasant St. #203, Portland, ME 04101

Checks should be made out to New Dance Studio. Questions about registration or classes? Call: 207-780-0554