REGISTER

Student Name

First Name

Last Name

Age

Class

2nd Technique Class

For Students in Levels 2 and up wanting to take 2 Technique classes per week.

Add-on Class

For Level 3-6 Students who want to add Conditioning, or Pointe

Registration Fee

$35 Individual or $45 Family

Parent's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Preferred Payment Option

Emergency Contact

Emergency Contact Phone

Allergies

How did you hear about us?

If you were referred by someone, please write their last name here so they can get $25 off their tuition.

Electronic Signature

WAIVER AND RELEASE FROM LIABILITY FOR DANCE INSTRUCTION I, have chosen to have my child, participate in dance instruction given by Heart to Toe Studios. I acknowledge that I understand the nature of the activities my child will be participating in and that my child is in the proper physical condition and capable of participating in the related activities, understanding that Heart to Toe Studios is not in any way responsible for making such a determination. In consideration of my child’s enrollment in any dance instruction program, I understand and agree on behalf of myself and my child, to release, hold harmless, and discharge Heart to Toe Studios, StaFit Sartell, and Princeton Fitness from all claims, costs, liabilities, expenses or judgments, including attorneys’ fees and court costs for any occurrences in connection with any dance instruction. I assume all risks to my child in connection with any instruction and further release Heart to Toe Studios, StaFit Sartell, and Princeton Fitness and its owners and employees from liability for any injury sustained by my child while he or she is enrolled in any dance instruction program, including all risks reasonably connected with such activity whether foreseen or unforeseen. I understand that Heart to Toe Studios, StaFit Sartell, and Princeton Fitness are not responsible for my child or other children under my supervision who are left unsupervised in the common areas and areas surrounding the dance studio and that Heart to Toe Studios will only be supervising my child when he or she is participating in scheduled dance activities, programs or instruction. I understand that Heart to Toe Studios, StaFit Sartell, and Princeton Fitness are not responsible for personal property that is lost, damaged or stolen while I or my child are at or on StaFit Sartell, or Princeton Fitness property. I acknowledge and agree that it is my responsibility to maintain my own accident and health insurance coverage that provides adequate coverage for myself and my child participating in Heart to Toe Studios activities and that Heart to Toe Studios does not provide accident or health insurance for those participating in its instruction, activities or programs. I authorize and agree that Heart to Toe Studios may take and use photographs, videos or likenesses of myself or my child as needed for its record-keeping, advertising and/or public relations projects and that I have no rights to the same and will not be compensated for the same. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation. I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO SIGNING.

Cancellation Policy: After October first, we expect you are committing to remain a student for the entire year. If you decide to no longer be a student, there will be a $150 Cancellation Fee. Cancellations caused by long-term health issues or injuries will be given grace.