Registration Form
Date_____________________
Student Name______________________
Birth Date/Age_____________________
Address_____________________________
City/Zip_____________________________
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Home Phone________________________
Cell________________________________
Email_______________________________
Emergency Contact___________________
Medical Problem_____________________
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Permission
_______________________________ has my permission to attend Karen`s School of Dance etc. I realize that there is always a risk of injury even under close supervision. As in any activity involving movement. I will not hold Karen McLavish, Karen's School of Dance etc. or any of her staff responsible. I have read the list of rules and guidelines for the 2023-24 dance year.
Parent or Guardian Signature
_______________________________
Please print and return to Karen McLavish 5536 Richfield rd Flint, mi 48506.