Dance Creations Dance Studio

  1401 E. Cottonwood ~ Springfield, Illinois 62703
217-529-TUTU (8888) Janet Cripe - Owner/Director
 

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Student Information Form

Printable Form Here (pdf)

Please fill out a separate form for each dancer.

Student Name
Age as of 9/1/2008
Birthdate
Desired Classes
Grade (fall 08)
Address
City
Zip
Home Phone
Mom Cell
Dad Cell
Mother's Name
Mother's Wk Phone
Father's Name
Father's Wk Phone
Parent's Email
Emergency Contact
Relationship
Home Phone
Cell Phone
How did you hear about us

Staff should be made aware of any physical limitations any dancer might have:

Please read the following information carefully

RELEASE FROM LIABILITY: I do hereby release Janet Cripe of Dance Creations Dance Studio and it’s Staff from any liability occurring on or around studio premises, or at any function held at other locations in connection with the dance
classes in which the student named above is/are enrolled. I declare that the student named above is/are in good health and can participate in dance education classes. Given the nature of the classes, and with the knowledge that injuries sometimes might occur, I have taken the proper steps to obtain accident, health, or hospitalization insurance, which would cover any sustained injury. In the event of an injury or emergency when I cannot be contacted, I give my permission for you to obtain medical services for the student named above.

Janet Cripe and DCDS may have my permission to publish photo(s) of my Child for any publication representing DCDS, including the school website which can be found at www.dancecreationsdancestudio.com.