2010-2011 Registration Form

FPlease Return this form with a $30.00 Registration Fee attatched (1 fee per family) Thank You

Parent(s) Name(s):_____________________________________                                                       _____________________________________ Address:_______________________________________________         City:_________________________Zip:______________________ Phone:(       )_______________  Age:______ Birthdate:___    -        -            E-mail:                                                                       Release Form: I _____________________________________ hereby release Vegas Valley Dance Academy and Ann Kern from liability of any kind or nature, excepting that only liability based upon gross negligence relative to actions or decisions that concern or affect any child. I have read and understand the studio policies and agree to try and adhere to them. Signature of Guardian:_________________________________ By checking one box, I am either allowing or not allowing pictures of my child to be posted on  www.vegasvalleydanceacademy.com. (Names and personal information will not be posted without guardian's explicit consent.) Pictures of my child can be posted on the team website: 1 Pictures of my child cannot be posted on the team website:1