Name of Dancer____________________Birthdate_______Parent/Guardian_____________________
Home Phone____________Billing Address_________________City______ST___Zip______
Email Address___________________________Emergency Information______________Number_______

Class Information
Day:________________  Time_________Tuition________

I __________________________ hereby fully understand and agree to the applicable terms which apply to me and my
child and am releasing Bridget’s Dance Conservatory and all employees against liability from injuries while at the dance
studio or at on site performances and/or against the loss of personal property. By signing this form you acknowledge
and agree to all terms described above.I have read and agree to abide by the studio policies of Bridget’s Dance
Conservatory. ______________________ ________
Signature                              Date

If you have two or more dancers this form must be filled out for each dancer. Thank you for reading through our
information policy. With Bridget’s Dance Conservatory you have made a positive and a great choice in you and your
child’s dance education. Welcome!!!

Bridget’s Dance Conservatory
Dance as if no one were watching.