registration


Student Information
Student's Name *
Student's Name
Student's Date Of Birth *
Student's Date Of Birth
Parent/Guardian Information
Parent/Guardian 1 Name
Parent/Guardian 1 Name
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Phone Number
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Phone Number
In Case of Emergency
Emergency Contact Name
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Phone Number
Classes
AGREEMENTS
Photo/Video Permission *
I grant SIUAC permission to use photos and videos of my child for promotional use.
I hereby agree that STRIKE IT UP DANCE STUDIO, INC. its directors and staff, are NOT responsible for any damages or liabilities due to theft, accident, or injury during, or resulting from my child's, or my, participation in any capacity of, or relating to any function or activity of the said STRIKE IT UP DANCE STUDIO, INC.

**I agree my electronic signature is the legal equivalent of my manual signature on this Agreement.**
Payments for classes are due by the first of the month. After the 15th of the month, a late fee of $30.00 will be applied to outstanding accounts and no additional store charges will be allowed until balance is paid. After the 30th of the month an additional $50.00 late fee will be charged. These fees are NON-REFUNDABLE!

I hearby assume all financal responsibiltiy for the above student(s) enrolled at STRIKE IT UP DANCE STUDIO, INC. I further understand that I will be charged and must pay for all classes until I have written a notification to SIUAC of my or my child's withdrawl from classes two weeks prior to leaving.
If it becomes necessary to refer this account for collection, I will be liable for all collection fees, including attorney fees, interest, etc.

**I agree my electronic signature is the legal equivalent of my manual signature on this Agreement.**