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Dance Student Information & Medical Waiver, This is the registration form to dance| Impdragon |
Posted: Jul 29 2008, 12:55 PM
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 Administrator  Group: Admin Posts: 382 Member No.: 1 Joined: 5-April 08  |
Dance Student Information
Last Name___________________ First Name________________________ D.O.B. ____ / ____ /____ Address__________________________________ City________________________ Zip___________ Contact Phone______________________ Contact E-mail (optional)_______________________________ Grade________ Male/Female Parent/Guardian Information Mother’s Name_______________________________________ Daytime Phone_____________________ E-mail (optional)_______________________________________ Evening Phone_____________________ Father’s Name_______________________________________ Daytime Phone_____________________ E-mail (optional)_______________________________________ Evening Phone_____________________ Person to contact in case of Emergency when parent/guardian cannot be reached Name ______________________ Daytime Phone ___________________ Evening Phone ____________ Child’s doctor _____________________ Doctor office’s phone number ________________ Preferred hospital in case of emergency _____________________ Injury Waiver/Medical Consent In consideration of my child being accepted in the BMT Dance Crews program, I do hereby waive and release the BMT Dance Crews Staff of all rights and claims for damages sustained and suffered by my child in connection with his/her association and participation in the BMT Dance Crews programs. In the event I cannot be reached in an emergency, I do hereby give to the BMT Dance Crews Staff permission to secure proper treatment for my child as named above. Parent’s Signature___________________________________________________ Date__________________________ Due to ordering and planning requirements, no refunds will be given after a program begins Thes forms will also be available at All lessons and classes will be taught at: Beaumont Meltropolitan YMCA 3455 Sarah Street Beaumont, Tx 77705 to pick up and fill out. This post has been edited by Impdragon on Jul 29 2008, 12:57 PM -------------------- YOUTUBE CHANNEL COMING SOON
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