Student Name *
Student Name
Student Date of Birth *
Student Date of Birth
Address *
Address
Phone *
Phone
Emergency Phone #
Emergency Phone #
Parent Name
Parent Name
Parent name needed when registering a child.
Studio Injury Waiver Form *
As with any physical activity or sport there is always a potential for injury to the participants. Rehearsing, practicing or performing dance is no exception. Flor de Liz Dance Studio strives to maintain a professional studio and the safest conditions possible for the dancers and staff, however, Flor de Liz Dance Studio is not responsible for any accidents or injuries that might occur to students or staff engaged in the activiites associated with dance. I agree not to hold Flor de Liz Dance Studios responsible for any injury or accident that might occur while engaged in activities associated with rehearsing, practicing or performing dance.