Enrollment - Windsor Dance Academy

Dancer Information

First Dancer's Name*

First Last

Date of Birth:*

Medical Conditions / Allergies

I'm interested in...

Ballet
Jazz
Hip Hop
Summer Camp
Adult Classes

Second Dancer's Name

First Last

Date of Birth:

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Numbers:

In case of emergency, illness of accident to your child, Windsor Dance Academy is authorized to contact or release your child to the following people listed below.

Mother

Mother's Name*

First Last

Mother's Email*

Best Phone Number*

Best Phone Number

Cell
Home
Work

Alternate Phone Number

Cell
Home
Work

Father

Father's Name*

First Last

Fathers Email

Best Phone Number*

Best Phone Number

Cell
Home
Work

Alternate Phone Number

Cell
Home
Work

Other

Name

First Last

Relationship

Phone Number

Cell
Home
Work

Other

Name

First Last

Relationship

Phone Number

Cell
Home
Work

Newsletters*

Sign me up for exciting announcements and events

How did you hear about Windsor Dance Academy?

Message

The undersigned agrees to idemnify, defend and hold harmless Windsor Dance Academy, it's agents, employees or persons acting on their behalf, for and from all claims, liability, loss and expense, including attorney's fees, asserted or incurred as a result of the acts of the enrolled student, the undersigned, their agents, employees or persons acting on their behalf.

Signature*

Name

This field is for validation purposes and should be left unchanged.

Enrollment Request Form

Dancer Information

Emergency Numbers:

Mother

Father

Other

Other

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