|
Ballet Center of Houston Summer 2006 Registration Form Date_____________________________________ First Name_______________________________ Last Name________________________________ Birthday_____________ Age____ Grade______ Parents__________________________________ Address__________________________________ City______________________ Zip___________ Home#____________________________________ Cell#____________________________________ Emergency Name___________________________ Emergency Number_________________________ Class Name/Day___________________________ Class Time_______________________________ Tuition Total____________________________ Date Paid________________________________ Amount Paid______________________________ Ck or Rec#_______________________________ Medical conditions we should know about? _________________________________________ |
|
Agreement:
I agree that I will not hold Victoria Vittum, Gilbert Rome, Ballet Center of Houston or any of its agents, employees or representatives liable for any injurys sustained or illness contracted while a student at he school. _________________________________________ Parent Signature and Date |