The Right Step Dance Studio

Student Name:  _______________________________________________

Address:__________________________________   Zip Code  _________

Parent/Guardian Name:  _______________________________________

Home Number:    ______________ Day Time Number: ______________

                                                                                        (in case of cancellations)

Emergency Contact:  _______________________ Number ___________

E-Mail Address: ______________________________________________

Grade: _________________ Birth date: ___________________________

Class Registering in:  Level: ______________ Class: ________________

                                                                                     (Tap, Jazz, Ballet, Pointe)

                         I acknowledge that an Injury Waiver/Payment Agreement form will have to be signed

                  the first day that my child(ren) attend class.