Registration

Name *

First Name

Last Name

Date Of Birth *

MM

DD

YYYY

Class Choice *

Play Group Tumbling - Monday, 4:30 - 5:00 PM (Includes Sensory Gym From 5:00 - 5:30 PM)

Special Stars Tap - Wednesday, 6:30 - 7:00 PM

Special Stars 2 - Wednesday, 7:00 - 7:45 PM

Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

• In attending Stephanie’s Academy of Dance Inc and / or Special Stars Inc NFP, taking dance, fitness, Yoga, and acrobatics classes and otherwise using the studio, sensory gym, and fixtures therein. I understand that I do so at my and my minor child’s own risk. • Stephanie’s Academy of Dance Inc or Special Stars Inc NFP shall not be liable for any damages arising from personal injuries incurred by me in, on or about the premises of Stephanie’s Academy of Dance Inc or Special Stars Inc NFP. Relative to our attendance at the studio, taking dance, utilizing the sensory gym, fitness, yoga, and acrobatics classes or otherwise using the studio and fixtures therein. • I assume full responsibility for any injuries or damages which may occur to me and/or my minor child in, on, or about the premises of Stephanie’s Academy of Dance Inc or Special Stars Inc NFP, and I do hereby fully and forever release and discharge Stephanie’s Academy of Dance Inc, Special Stars Inc NFP, their directors, instructors, and employees from any and all claims, demands, rights of action or causes of said Stephanie’s Academy of Dance Inc, Special Stars Inc NFP, classes, studio, sensory gym, and fixtures thereof. *

I Agree

Tuition Payment Terms ~ Tuition is Non-Refundable regardless of cause. ~ $40.00 Fee for NSF Checks *

I Agree

Stephanie's Academy of Dance / Special Stars Inc NFP has my permission to put any picture on social media of my child or myself. *

Yes

No