Five Flags Dance Academy
Five Flags Dance AcademyFive Flags Dance Academy
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Five Flags Dance Academy
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Registration   		   
 
Registration Date: 2008/05/13         Monthly Dues:  40.00
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Five Flags Dance Academy
1903 East Olive Road
Pensacola, FL 32514
______________________________________________________________________
RELEASE AND HOLD HARMLESS AGREEMENT

I/We, the undersigned parents or guardians of _________________________________________________________, agree to permit the above named child to participate in the dance program and insturction as provided by Five Flags Dance Academy.

I/We the undersigned parents or guardians of the above named child, do release and hold harmless the Five Flags Dance Academy, its agents and employees, of and from all claims and liability by reason fo any injury suffered by said child as a result of participation in the above mentioned program, whether or not it is alleged that such injury occurred by reason of the sole fault or negligence of the said Five Flags Dance Academy, its agents or employees or in part as a result there of.

Date this _______ day of ______________________________,20_______

__________________________________________________________________
Parent/Guardian

CONSENT FOR MEDICAL TREATMENT I/We, the undersigned parents or guardians of ________________________________________________________, authorize any officer/director of Five Flags Dance Academy, to consent to all necessary medical care and treatment of the above named child whether such involves first aid, the care and treatment of a medical doctor, the emergency room or admission to a hospital.

Date this _______ day of ______________________________,20_______

__________________________________________________________________
Parent/Guardian

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Sign below to confirm that you have read the policies and information.

I have read and fully understand the Policies and Information of Five Flags Dance Academy and I agree to follow the rules and regulations as they are written.

Parent's Signature _______________________________________________________

______________________________________________________________________

Child's Name ______________________________________________________

Today's Date ______________________________________________________

________________________________________________________________

Official Use Only

Enrollment Date: ______/______/______

Dance Yrs Completed ______ Total ______ Ballet ______ Tap ______ Jazz

Class: __________________________ Day: ____________ Time: ____________

                   
Five Flags Dance Academy
History    Facility    Classes Offered    Dress Code    Fees & Payments    Schedule    Recital    Faculty
Dance News    Important Dates / Calendar    Policies & Procedures    Registration Form    Contact Us
 
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Five Flags Dance Academy