Register here

Name of Student *
Name of Student
Address *
Address
Date of Birth *
Date of Birth
Mothers Name
Mothers Name
Mothers Phone Number
Mothers Phone Number
Fathers Name
Fathers Name
Fathers Phone Number
Fathers Phone Number
Guardian Name
Guardian Name
If not the mother or father.
Guardian Phone Number
Guardian Phone Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Please specify any concerns that we need to know regarding your child. E.g. Limitations, Allergies, Health Complications, etc.
Preferred Class *
Please select at least one.
Release Agreement *
I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Miss Amy's Dance, its officials, officers, employees, volunteers and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees. If a student drops out of a class for whatever reason, please notify the school promptly so you will not be charged additional tuition. A 30 day notice is required. Proper dance wear and shoes are required. The school will enforce a dress code for all ages.
Please sign your full name and click submit.