Professional Documents
Culture Documents
Dominique Fewell
Dominique Fewell
Mother’s Name__________________________________________________________
Ages older 4s—5 Fees (see back for recital and costume fees):
Insurance Carrier_________________________________________________________
$25.00 per family List all previous injuries, physical limitations, and current medications_________
Tuition: _________________________________________________________________________
(1st month due at time of registration) Notice of Termination: I understand that a written one (1)
month termination of participation notice be submitted to
*You may pay a one time TUITION fee for the the Director. I understand that in any activity the
potential exists for injury, minimal to catastrophic.
entire year for $215.00 plus the registration fee.
, it’s employees, agents,
All other discounts will apply to the one time
officer’s, and directors shall not be responsible for losses
fee. Please call Director for details. and damages associated in any activity, exhibition, or travel to or from any event in which the
named above is involved. Furthermore, I hereby release staff to render first aid in the event
Discounts: of any injury or illness, to seek medical assistance if deemed necessary and to transport to a
medical facility or to call an ambulance.
Sibling Discount: $7.50 PER CLASS
Two or more classes per student:
$5.00 PER MONTH Parental Signature ____________________________ Date________________