Student Name
*
First Name
Last Name
Student Birthdate
*
MM
DD
YYYY
Student Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Primary Contact Name
*
Primary Parent or Guardian for students under 18 years
First Name
Last Name
Primary Contact Relationship to Child
*
Select one
Mother
Father
Grandparent
Caretaker (Babysitter/Nanny)
Other
Primary Contact Phone
*
(###)
###
####
Primary Contact Email
*
Secondary Contact Name
Secondary Parent or Guardian for students under 18. In an emergency, the secondary contact will be called if we cannot reach the primary contact.
First Name
Last Name
Secondary Contact Relationship to Child
Select one
Father
Mother
Grandparent
Caretaker (Babysitter/Nanny)
Other
Secondary Contact Phone
(###)
###
####
Secondary Contact Email
Name
First Name
Last Name
Phone
(###)
###
####
Classes
Please check the class or classes you intend to register for for the spring semester. SCOD will reach out to you if the class you selected is full or if there is a question whether the class selected is appropriate.
NEW AND RETURNING STUDENTS: If you need help with placement, please email schramelconservatory@gmail.com for guidance. Students typically spend several years at the same level and continue in the same level from the fall semester into the spring semester.
1.
*
I understand that dance is a physical art form and injury is inherent. Every effort has been made to keep the studio a safe and appropriate environment for learning and performing dance class. If an injury does occur, the student or student's parent/guardian is responsible for medical expenses incurred and will not hold Schramel Conservatory of Dance liable.
2.
*
The Directors and Faculty are qualified to teach students at the appropriate level and have the right to advise a student if they feel the student is not ready for a certain level. I understand that every effort has been made to place students at the appropriate level for their abilities.
3.
*
I understand that the student may be touched appropriately by the teacher in order to achieve a certain position of the body as it pertains to the dance form.
4.
*
Every parent/guardian is responsible for the student before class time and once the student leaves the studio in which dance class has taken place. The teacher will only release the student to a parent or guardian known to be a responsible party for the student. Once the child leave the studio, he/she must be accompanied by an adult when moving from the Conservatory through the building or to the street.
5.
*
All students under the age of 6 must have a parent/guardian in the waiting area during class.
6.
*
I certify the student has no health issues which could impact or interfere with their ability to safely participate in dance class. If there is a health issue, I will notify the directors of the problem.
Electronic Signature
*
I hereby declare all of the above to be true to my knowledge. I understand all of the policies above and sign my name below as a legal guardian of the student.
Date
*
MM
DD
YYYY
Anything additional you feel we should know?
