ANASTASIA'S SPOTLIGHT DANCE

A fun, quality, Christian based dance studio!

Spotlight Dance MAIL-IN REGISTRATION    

  
Mail to:     Spotlight Dance, P.O Box 76, Churchville, NY 14428

RegistrationFee: $15-first student, $10 second, and $5 third
Parent's Name:________________________________________________________
Address:_______________________________________________________________
City, State, Zip Code:_____________________________________________________
Home Phone: __________________________  Cell:____________________________ 
Email:_________________________________________________________________
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Student:_________________________________  Age:_______   Birthdate:__________

Health Concerns:________________________________________________________
Classes Registering for:

Day:___________ Time:___________    Type:_______________ Teacher:___________

Day:___________ Time:___________    Type:_______________ Teacher:___________

Day:___________ Time:___________    Type:_______________ Teacher:___________

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Student:________________________________  Age:_______   Birthdate:___________

Health Concerns:________________________________________________________
Classes Registering for:
Day:____________ Time:___________    Type:______________ Teacher:___________


Day:____________ Time:___________    Type:______________ Teacher:___________


Day:____________ Time:___________    Type:______________ Teacher:___________

ACKNOWLEDGEMENT OF RISK
Participating in dance class or any related event always runs the risk of personal injury and loss or theft of personal property.  The purpose of this acknowledgement is for you tounderstand that there is a possibility of personal injury or property damage beyond the control of Spotlight Dance LLC.  Spotlight Dance LLC is not responsible for personal injury and loss or theft of property.  By signing this form you are acknowledging that you have read and understand the risks and liabilities of participation.  

Guardian’s Signature:___________________________________   Date:_____________