Steps 'N Motion Dance Studio 2008-09 Registration

Single Student Registration
 
A $48 non-refundable registration fee is required to register online using this form.
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Please complete all information using your TAB key to move through the form.  Do NOT use the ENTER key to move through the form.  Click on the SUBMIT button to submit the form and proceed to the payment page.  All fields are required.
 Please choose one:
Returning Student:  
New Student:  
Parent(s) Name:  
Street Address:  
City: State: Zip:
Home Phone: Cell Phone:
E-mail:  
           
Studio Choice: (Please select one)        
The Fountains        
Wesley Chapel        
Student's Name:    
Age: Birthday: mm/dd/yyyy    
Please provide your class / day / time preferences and any comments.    

Notice:  Steps ‘N Motion Studio, Inc. and its agents urges for all students to obtain a physical examination from their physician prior to attending any class.

 I have full knowledge that by nature class participation can frequently include exercise and body contact along with associated dangers.

In recognition of the possible dangers connected with any physical activity, students hereby knowingly and voluntarily waive any right of cause of action of any kind whatsoever arising as a result of such activity from which any liability may or could occur to Steps ‘N Motion Studio, Inc., Sabrina LeClair, its officers, agents, or employees or instructors.

I agree to waive claims against any person or organization connected with Steps ‘N Motion Studio. Inc. for any injuries I may sustain and likewise assume full responsibility for all my actions in connection with any classes.

Please type your name in the box provided below indicating you have read and understand the above notice.  Submitting this form indicates your understanding and agreement with the Hold Harmless notice provided above.
Signature of Parent (for participants under 18)
Click SUBMIT to proceed to payment page (using Paypal or your credit card)