Parent Name *

This is the name that your account will be under in our computer system.

First Name

Last Name

Phone 1 *

(###)

###

####

Phone 2 *

(###)

###

####

Please check all the subjects you would like to register for. *

Sorry, not all subjects are offered at both locations. Please check our schedule on our website.

Combo (ballet/jazz and tap, 1 hr, ages 2.5+)

Ballet (1 hr, ages 6+)

Lyrical/Contemporary (1 hr, ages 8+)

Hip Hop (45 min, ages 6+)

Musical Theatre (45 min, ages 8+)

Clogging (45 min, ages 7+)

Colorguard (1 hr, six week sessions)

Danceline Prep (45 min, ends after tryouts)

Acro (1 hr, ages 2.5+)

Baton (1hr, ages 6+)

By checking this box, I am stating that I have read and agree to the terms of this registration. *

If I decide to withdraw my child after registering, I realize that I will continue to be billed until I officially fill out a withdrawal form through the office. If I withdraw my child after October 7th, I understand that I will be financially responsible for the full payment of the costume ordered for my child and have until the last week of class to pick up the costume. As a participant, or parent/guardian of a participant in the program, I acknowledge that there are risks of injury and I agree to assume those risks which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such a program, including traveling to and/or from the activities. I release all claims which may arise against, and agree not to sue Miss Kelley's School of Dance, Inc. and its officers, agents, employees and volunteers from any and all claims by other parties resulting from injuries, damages and losses caused by me or my minor child arising out of, connected with, or in any way associated with the activities of the program. In the event of any emergency, I authorize Miss Kelley's School of Dance, Inc. officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I also give Miss Kelley's School of Dance, Inc. permission to use my child's image in its promotional materials and publicity efforts.

I agree.