*Student Name:
*Parent Name:
*Address:
Email:
Please check if you would like to receive studio information by email.
*Phone:
* Student's Birthdate:
*School / Grade as of Sept 2010:
Classes Registering: (please indicate times of classes)
Previous Dance Experience / Where
Referal
 Internet / Online
 Advertisement
Direct Mail
Other
How Did you hear about us?
Payment:
There is a $30 Registration fee.  Tuition is due the first day of classes.
I have read and agree to the terms and conditions stated below.
REGISTRATION
You can enroll your child for dance classes by filling out this form.  There is a $30 Registration fee.  
After you submit your form, you will receive a confirmation email withing 24hrs.  After you hit submit,
you will be taken to a secure site for payment.
I hereby consent to participating in dance/yoga classes at Saucon Valley Dance Conservatory (SVDC).  I do hereby agree to indemnify and save
harmless SVDC, it’s instructors, members and authorized guests, as well as its agents and employees, of and from any liability of any nature or kind
whatsoever arising out of or in any way connected with any claims or demands made by or on behalf of the participant.
I have read and understand the terms of this consent and indemnification as set out above.  By checking the 'agreement box' above, I agree to the
terms stated above.