Broadway Bound Dance Center

 2010 Summer Registration Form

 

Mail to: Broadway Bound Dance Center, 17 Willow St., Natick MA 01760

Student’s Name:

Age:                                                Date of Birth:                                        Grade:

Address:

City:                                                                        State:                         Zip:

Emergency Contact:                                               Relation:

Emergency Phone Number:                                    Medical Information:

Parent #1:                                                Phones: (H)                          (C/W)

Parent #2:                                                Phones: (H)                          (C/W)

Family e-mail:                                                Student e-mail:

Please write the theme of the dance week(s) your child will be attending & the cost
Theme: ___________________________	Week:_________________________	Cost:________________
Theme: ___________________________	Week:_________________________	Cost:________________
Theme: ___________________________	Week:_________________________	Cost:________________
Theme: ___________________________	Week:_________________________	Cost:________________
Theme: ___________________________	Week:_________________________	Cost:________________
	Total Cost:	_________________
Discounted Packages: Please write in which camp you choose as your 4th & free camp!
Sign up for 3 weeks, get the 4th Free! (of equal or lesser value)
Theme: ___________________________	Week:_________________________	Cost:________________

Please make checks payable to Broadway Bound Dance Center or BBDC ________________________________________________________________________________  I, the undersigned Parent or Guardian of the above student release BROADWAY BOUND DANCE CENTER, including instructors and assistants from any and all injuries which may occur from training, practicing, performing and/or during any event or activity. I also agree that I am responsible for the health and accident insurance and any medical costs for the above student incurred due to injury including, but not limited to, emergency medical transportation and treatment if the need arises. I understand that BBDC has a NO REFUND POLICY. If a student drops, the account will be credited the balance and will be saved for up to one year. I also give my permission for the public display of any studio pictures that my child may be in.    Print Name:__________________________ Signature:___________________________ Date:_______