Students Name

 

T-Shirt Size Choose Option 2-4 6-8 10-12 14-16 Adult S Adult M Adult L Adult XL

 

Age (current)

 

Birth Date

 

Mailing Address

 

City

 

State

 

Zip

 

Phone Number

 

Alternate Phone

 

Parent/Guardian Name

 

Email

 

Emergency Contact Name

 

Emergency Contact Number

 

List medications/medical information that teachers need to be aware of:

 

 

School Attending

 

Location You are Interested in Attending:

 

Choose Location Choose Option Anderson Studio 1005 N. Main Street Anderson Recreation Honea Path Rec. First Presbyterian First Baptist Whitefield Anderson YMCA Convenant Christian Pendleton on the Square Honea Path Elementary

 

Classes/Services Interested In:

 

classes

 

Would you like to "Go Green"? All notes and newsletters will be sent via email and no paper notes in class. All email notes will be sent home prior to their class time each week.

 

Go Green Choose Option Yes No

 

Disclaimer & Agreement

 

I (enter your name)

 

am enrolling (student's name)

 

to participate in a program offered by Upstate Dance. I give permission for my child to participate in all activities associated with the service provided. I hereby release Upstate Dance, Lindsey Rhodes, Hazel Cartee all teachers, all assistants, and all facilities of any and all liability. I understand there is a risk of injury associated with any class type and accept this risk. I agree to all class policies including fees, outfits, attendance, class observation, and any other policy posted at class or on the website. I understand that I must contact Lindsey Rhodes by mail, email, or phone in order to drop my child from the program. Failure to do so is accepting responsibility for fees until notice is given.

 

E Signature

 

Date

 

Type Black Letters   

 

** By typing your name in the E Signature field, you are agreeing that all information is correct to the best of your knowledge and that you agree to the terms, conditions, and policies set forth by Upstate Dance. **