Kick Winter/Spring 2010 Registration Form

Name: DOB:

Parents Name:

Address:

City: Zip Code:

Phone: E-mail:

Which Class (es) are you registering for?

(Please select classes carefully, transfers may not be available)

Class Fee: ____________________

Registration Fee: ___________________

Costume Payment ($75) _______________

Total Due: _______________

Current Payment: _________

New Students only – How did you hear about Kick?

I understand that dance is an inherently risky activity and I agree to hold harmless, Kick, Vanessa Berry, and any other instructor at Kick for any bodily injury sustained while participating in any class or performance associated with Kick. I also understand that all payments are final and refunds and make up classes are not offered. Payments are due at time of registration, 2/1 and 4/1. Final payment is due 4/1/10. I have read the Winter/Spring 2010 Dance Brochure and I am familiar with the required dress codes for dance classes, (check with Vanessa BEFORE you purchase shoes!) Kick has an open door observation policy; however parents are strongly encouraged to limit observation to the last five minutes of class.

Parent/Guardian Signature:

Date:

740 River Road

Fair Haven, NJ 07704 (732) 212-1322

www.kickstudio.com