List Dance Training:______________________________________________________________________
Studied: (circle) ballet, pointe, jazz, tap, hip hop, other:_________________________________________
Where:____________________________________________ Number of years:______________________
List any physical limitations:_______________________________________________________________
Injuries:________________________________________________________________________________
How did you hear about us? (please check)
Website __ Friend __ Driving By __ Phone Book __ Newspaper __ Other:__________________________

Class space is reserved. Therefore no refunds or credits can be given for missed or dropped classes or dance camps. Registration fee, deposits or tuition will not be refunded.

The parent or adult student signing this release acknowledges our policy as stated on the tuition form and understands that his/her child or adult student is taking classes at his/her own risk and agrees to hold Cameo/Carrabba Dance Inc., its instructors, and/or assignees harmless in the event of any physical injury to the student. Person signing this form is responsible for payment of registration fee, camp fees and/or tuition. Registration Fee is $30.00 per year. Please enclose with registration form.
Tuition enclosed: $__________________ or deposit of $__________________ is enclosed.
Check #___________ Visa/Mastercard #_________________________________ Exp. Date:____________

X________________________X______________________________________________________________
Date Today                             Parent or Guardian Signature / Adult Student Signature