Fox Hill Dance Academy, Inc.
REGISTRATION FORM
Date: ______________
Student name(s)_______________________________ Age___
Address_____________________________  Zip code___________
Telephone #____________________
Emergency tel.#________________________
e-mail address__________________________________________
 Parent/Guardian name ____________________________________

Classes: Ballet__;  Tap__;   Hip hop/Jazz__;   Pre-School__; Other:___
Class day and time: _______________________________________
Class teacher: ___________________________________________
Class fee:    __________ 
Registration fee:  $20.00 per family
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." Initial ___   
Mail Registration Form to:
Fox Hill Dance Academy, Inc.
2275 Fox Hill Drive
Indianapolis, IN 46228
Fox Hill Dance Academy
2275 Fox Hill Drive
Indianapolis, Indiana 46228
www.foxhilldanceacademy.com
317-255-0173
 
Walk in registration
every Monday 1:00 - 5:30 PM
 Wednesday and Friday 1p-5p
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