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BEACH DANCE SCHOOL

REGISTRATION FORM"

(Please Print)
NAME:________________________________________________________________

DATE OF BIRTH:(M \ D \ Y)_______________________________________________

PARENTS (GUARDIANS):________________________________________________

TEL. #:(HOME)_________________________________________________________

CELL #________________________________________________________________

ADDRESS:____________________________________________________________

______________________________________________________________________

E-MAIL:_______________________________________________________________

IN CASE OF EMERGENCY CONTACT:______________________________________

LIST OF ANY ALLERGIES:________________________________________________

DANCE EXPERIENCE: __________________________________________________

EXAMS\LEVELS COMPLETED:____________________________________________

LIABILITY WAIVER

I will not hold Beach Dance School or any of its associates accountable for any loss,
damage, injury or accident that may occur in or around Beach Dance School, located
2493 Queen street East, Toronto.
_________________is here by the consent of his/her parent/guardian______________.

I have read and agree to comply with the policies set forth by Beach Dance School.

SIGNATURE:__________________________________
DATE:___________________

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