Kick Winter/Spring
2010 Registration Form
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Name: DOB:
Parents Name:
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Address:
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City: Zip
Code:
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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
Parent/Guardian Signature:
Date:
Fair
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