“IHS” Summer 2017 Registration Form

DATE:_____________

E-mail:____________________________ This is our #1 form of communication please print clearly. Let us know if you do not check e-mails regularly. How did you hear about us?_______________________________ Returning Student or NEW Student (Circle One) Parent’s Name:____________________________________________________________________________________ Home Phone #:_____________________ Work Phone #:___________________ Cell #:________________________ Can we text you? Y or N Cell provider ______________ (so that we can e-mail you through our our e-mail system)

Home Address:_________________________________________ City, State, Zip:_____________________________

Please indicate if you are doing the 4 week dance pack, Mini camps or Intensive First & Last Name of Student:____________________________________________ Age:_______ Grade:___________ Date of Birth with year:________________________________________________ Please list name of class, day of class, and time of class in the spaces provided. 1st Class:______________________________________ 2nd Class:_________________________________________

First & Last Name of Second Student:_____________________________________ Age:_______ Grade:___________ Date of Birth with year:________________________________________________ 1st Class:______________________________________ 2nd Class:_________________________________________

First & Last Name of Third Student:_______________________________________ Age:_______ Grade:___________ Date of Birth with year:________________________________________________ 1st Class:______________________________________ 2nd Class:_________________________________________

Please list dates of Mini Camps 1. _______________________________________ 2. __________________________________

3._____________________________________ 4.___________________________________

5.____________________________________________

******PLEASE REVIEW & SIGN THE BACK******

“LIKE” the In His Steps Christian Dance Studio FACEBOOK PAGE for weekly info & updates. FOR ACCOUNTING USE ONLY Tuition Amt Paid:

Quick Books

Check Amount and #: Cash: Amount $

E-mail Receipt #

Please list any allergies or medical conditions the instructor should be aware of:

IN CASE OF EMERGENCY, PLEASE CONTACT (other than above) Name:______________________________________________ Phone: ______________________________________

A $35.00 service fee will be charged on all returned checks All tuition, fees, and costume payments are non-refundable. By signing I am agreeing to read or have read the entire handbook so that I understand payment schedule, studio, schedule, fees & policies. Release, Waiver, and Indemnity Agreement In consideration of permitting me (students name),_______________________________ to enroll and participate in activities and class instruction of lessons given by In HIS Steps instructors at the facility of In HIS Steps in the city of Pensacola, Escambia County, and state of Florida beginning on this_____ day of _______ 20____. I hereby voluntarily release, discharge, waive, and relinquish any and all actions or cause of action for personal injury, property damage or wrongful death occurring to me arising as a result of ongoing or receiving instructions in said activity or any activities incidental therein wherever or however the same may occur and for whatever period said activities or instructions may continue. I, for myself, my heirs, executors, administrators and assigns hereby release, waiver, discharge and relinquish any actions or cause of action, aforesaid, which may hereafter arise for me and for my estate and agree that under no circumstances will or my heirs, executors, administrators, and assigns prosecute, present any claim for personal injury, property damage, or wrongful death against In HIS Steps its facilities or any of its officers, instructors, agents or employees for any said causes of actions, whether the same shall arise by the negligence of any said persons or otherwise. It is my intention by this instrument to exempt and relieve In HIS Steps and its officers from any liability for personal injury, property damage, or wrongful death caused by student negligence. IHS reserves the right to alter class schedules, for any reason temporarily or permanently, without fault. I acknowledge that I have read the above paragraphs and have been fully and completely advised of the potential dangers incidental to engaging in the activity and instruction of dancing, tumbling and martial arts and am fully aware of the legal consequences of signing this instrument. I give permission for videos and photos of my child to be used for advertising and printing for In His Steps

Signature of Parent/Guardian __________________________________ Date _________ I acknowledge that I understand the summer tuition is non-refundable if I drop before or during the session. ______________________ Date _____________