Fox Hill Dance Academy, Inc.          REGISTRATION FORM


Student name _____________________________Age _______

Address_____________________________ Zip code__________

Telephone #____________________ 

​e-mail ______________________________(important

Emergency tel.#________________________


Parent/Guardian name _________________________________

Classes: Ballet__;  Tap__;   Hip hop/Jazz__;   Pre-School__; Other:___

Class day and time: _______________________________________

Class teacher: _____________________________

Class fee:    __________ 

Registration fee:  $25.00 per student

Enclose your personal check and write your drivers license number on the check.  Or use the convenience of a charge card:

Master card__  Visa__  Discover__ Card#______________________ 

Expiration month _____  year ______  V code on back_____________

Signature    ______________Injuries/Waiver of Liability/Authorization:

"I understand that there is a risk of potential injury associated with dance classes and performances.  I represent the above named student is in good health and physically capable of participating in dance classes, performances, and recitals. On behalf of myself and the above-named student, I hereby waive and release any claim against the Fox Hill Dance Academy and/or Instructors of Fox Hill Dance Academy Inc., arising out of a personal injury occurring in connection with dance classes, performances, or otherwise occurring in or around the dance school or other locations of performances or recitals.  I accept responsibility for obtaining appropriate accident, health and hospitalization insurance to cover the student in the event of personal injury. In the event of an injury or other medical emergency if I can not be reached; I authorize a staff member of Fox Hill Dance Academy to seek any medical assistance required." Your Initial ___   

Signed___________________ date ________________

Mail Registration Form to: Fox Hill Dance Academy, Inc. 2275 Fox Hill DriveIndianapolis, IN 46228
Fox Hill Dance Academy
2275 Fox Hill Drive
Indianapolis, Indiana 46228

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