Name * First Name Last Name Relationship to Dancer * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### Additional Phone Number (If Applicable) (###) ### #### Email 01 * Dancer Name * First Name Last Name Sex * Male Female Age * Birth Date * MM DD YYYY Boarding or Commuting * Boarding Commuting Meal Plan *If Commuting Yes No Room Mate Preference Yes No Room Mate Preference Name (If Applicable) Class Age Division * Age 6-8 Age 9-12 Age 13-15 Age 16 & Over Showcase Performance Choice 01 * “All dancers will participate in our Hip Hop production to close the showcase.” hip hop modern tap jazz contemporary musical theater ballet Showcase Performance Choice 02 * hip hop modern tap jazz contemporary musical theater ballet Showcase Performance Choice 03 * hip hop modern tap jazz contemporary musical theater ballet Dancer Name 2 First Name Last Name Sex Male Female Age Birth Date MM DD YYYY Boarding or Commuting * Boarding Commuting Meal Plan *If Commuting Yes No Room Mate Preference Yes No Room Mate Preference Name (If Applicable) Class Age Division Age 6-8 Age 9-12 Age 13-15 Age 16 & Over Showcase Performance Choice 01 “All dancers will participate in our Hip Hop production to close the showcase.” hip hop modern tap jazz contemporary musical theater ballet Showcase Performance Choice 02 hip hop modern tap jazz contemporary musical theater ballet Showcase Performance Choice 03 hip hop modern tap jazz contemporary musical theater ballet Emergency Contact Name * First Name Last Name Emergency Contact # * (###) ### #### Emergency Contact Name 02 * First Name Last Name Emergency Contact # * (###) ### #### Special Health Conditions * *Please include physical, psychiatric, or behavioral conditions Allergies * *If Yes, Please list Does your child have Asthma? * Yes No Please list any activities your child may not participate in, or any problems which may require special attention: * Terms of Agreement * Enrollment Policy: Dancers are enrolled on a 'first come' basis. Deposit is due at time of enrollment, we cannot hold your space without a deposit. Cancellation Policy: A non-refundable processing fee of $100 will be retained if you have to cancel your child’s reservation and do so prior to your tuition due date. After that date, the full 25% deposit will be retained. I, the undersigned Parent or Guardian of the above student(s), release the Gold School, including instructors and assistants from any and all injuries which I may sustain while training, practicing, and performing or during any event or activity. I also agree that I am responsible for their health and accident insurance and any medical costs incurred due to injury. I also give my permission for emergency medical transportation and treatment at my expense if the need arises. I also give my permission for the public display of any NO BOUNDARIES photographs and video that my child may be in. Accept Decline Signed by * Write full name First Name Last Name Thank you!
