Register for Class – Gayle Tingey School Of Dance

Adults please disregard any non-applicable information.

Dancer Information

Dancer #1 Full Name (required) Dancer Date of Birth (required) Class(es) hold Ctrl to select multiple (required) Day(s) hold Ctrl to select multiple (required) Prior Training (required)	Dancer #2 Full Name Dancer Date of Birth Class(es) hold Ctrl to select multiple Day(s) hold Ctrl to select multiple Prior Training
Dancer #3 Full Name Dancer Date of Birth Class(es) hold Ctrl to select multiple Day(s) hold Ctrl to select multiple Prior Training	Dancer #4 Full Name Dancer Date of Birth Class(es) hold Ctrl to select multiple Day(s) hold Ctrl to select multiple Prior Training
General Inforamtion
Phone Number (required) Email (required) Street Address (required)	Other Responsible Party Information
Parent/Guardian Contact Information
Parent/Guardian #1 Name(required) (required) Business or Cell Phone(required) (required) Occupation and Place of Employment (required) (required)	Parent/Guardian #2 Name Business or Cell Phone Occupation and Place of Employment
Additional Information
How did you learn about us? (required) Medical Conditions or Allergies (required) Holiday celebrations you would not like your child to participate in? (required) Which school(s) and grade(s)[for carpool purposes]? (required)

Payment Responsibility & Release of Liability

I understand and agree that photos and videos will be taken throughout the year at dance classes and activities and that these images may be published and/or used for advertising and/or promotional use by Gayle Tingey School of Dance (GTSD) and its agents. I relinquish the right to protest any such use or receive compensation.
I have read the studio policies and dress code information and agree to comply with all policies therein contained.
In consideration of the benefits derived from GTSD, I do hereby agree to hold harmless GTSD, its owners, operators, agents and employees, from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, that may be sustained by the participant and/or the undersigned, while in or upon the premises or in route to or from any of said premises or GTSD activities.
I understand that appropriate physical contact is required during the instruction of dance, and I give permission for instructors to make appropriate physical contact with my child for such instruction.

Electronic Signature of Parent/Guardian

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Registration.

Today's Date

Dancer Information

General Inforamtion

Parent/Guardian Contact Information

Additional Information

Payment Responsibility & Release of Liability