Registration Form
Slater’s Dance Studio
5809 Deale-Churchton Road   Deale, MD    20751
410-867-0500
www.slatersdancestudio.com
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STUDENT’S NAME:
AGE:                                                              BIRTHDATE:
ADDRESS:

CITY & STATE:

TELEPHONE:(Home)                              (Cell)                              (Work)                                              

EMAIL:

PARENT OR GUARDIAN:
	ADDRESS:
	CITY&STATE:
	CONTACT NUMBER:
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Medical Information:  Allergies, restriction, Special learning needs

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Class				Day, Time				Hours		_________________________________________________
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RELEASE FORM:  (To be completed by Parent/Guardian if Student is under 18
I________________________release SLATER’S DANCE STUDIO and it’s teachers from any liability, claims, judgments or demands arising as a result of any course of instruction or supervision at SLATER’S DANCE STUDIO  or any shows away from the studio.
SIGNATURE_____________________________________DATE__________________