2009-2010 Student Information:

Name:_______________________________________________ Date of Birth: ___/___/______ Age:______

Address:_________________________________________________City:______________________________

State:_____________ Zip:_________________ Dancer’s E-mail:___________________________________

Dancer’s Cell:____________________________ TEXT yes / no Home Phone:________________________

How did you hear about us:___________________________________________________________________

Previous Training:___________________________________________________________________________

__________________________________________________________________________________________

2009-2010 Parent / Guardian Information:

Mother’s Name:______________________________________ Cell:______________________ TEXT yes / no

Father’s Name:_______________________________________ Cell:______________________ TEXT yes / no

Address:___________________________________________________________________________________

City:_____________________________________________________ State:_______ Zip:_______________

Home Phone: _______________________ E-mail:______________________________________________

Preferred Contact Method:_________________________ Best Time to Contact:________________________

Additional Comments or Questions:_____________________________________________________________

2009-2010 Participation and Release Form

We, the staff at Triplett and Propst Performing Arts Studio, recognize our obligation to make sure our students and their parents are aware of the risks and hazards involved in the sport of dance and tumbling. By signing this waiver, you release Triplett and Propst Performing Arts Studio and all its employees from all claims on account of any injury which may be sustained by your child while attending any dance class, event associated with Triplett and Propst or outside performance. You also affirm you now have and will continue to carry proper primary medical, health, hospitalization and accident insurance which you consider adequate for the protection of your child.

I understand that upon enrolling my child at Triplett and Propst I am responsible for payment of tuition regardless of attendance. I have gone over the policy sheet and understand that fees are non-refundable. I give permission for my child’s photograph, or recorded performance or practice to be used for advertising purposes.

Parent Signature:_____________________________________________________ Date:_________________

Health Care Provider:________________________________________________________________________

Date Issued:_________________________________ Expiration Date:_____________________________