Session and Drop-in Class Waiver

Student Name *

Adult students please fill out your own name, students under 18 please put your own name and include a parent/guardian's below.

First Name

Last Name

Birth Date *

Please fill in dancer's birth date.

MM

DD

YYYY

Parent/Guardian Name

Please put a parent/guardian name if the dancer is under 18.

First Name

Last Name

Phone Number *

Please fill in your phone number to contact in case of weather emergency, issues with billing, class cancellations, etc. *Dancers under 18 should fill in a parent's phone number.

(###)

###

####

Emergency Contact *

Please provide an individual to contact in case of injury. For parent/guardians signing up teens, please provide an individual besides the person listed above in case of emergency.

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Student Address *

Please provide the dancer's address. This is used for billing purposes.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Person to Bill

*If different from adult student registering or above mentioned parent/guardian.

First Name

Last Name

What studio location is most convenient for you? *

Madison (located at 2605 S. Stoughton Rd.)

Sun Prairie (located within the Sun Prairie Ice Arena at 838 Grove St.)

Both are convenient

Are you interested in taking drop-in classes or a session length class (5 or 10 weeks)? *

Drop-in or Open Level classes are intended for intermediate level teens or adults with an existing dance vocabulary. Our Beginning and Continuing Ballet sessions are for teens or adults who wish to get a "crash course" in the basics and continue to build their Ballet knowledge. To read more about these class options, visit our "Classes" page.

Drop-In classes

Ballet Session

Both

Not sure

Which classes are you interested in? (Select all that apply)

Based on your answer above, let us know which classes you are thinking of signing up for!

Open Teen/Adult Ballet (Madison location only)

Open Teen/Adult Tap (Madison and SP locations)

Open Teen/Adult Jazz (SP location only)

Beginning Teen/Adult Ballet (5 week session, Madison location only)

Continuing Teen/Adult Ballet (10 week session, Madison location only)

Signature *

Signature accepting Statement of Understanding and agreeing to maintaining a valid credit card on file and authorizing payments on such card. Type your full name. Call studio at 608-221-4535 to provide card number or stop in prior to first payment date to provide card information. Do not email.

First Name

Last Name

Date of Signature *

MM

DD

YYYY