CREATIVE DANCE CENTER

   Home      Registration Form
Fill out information below, print and mail with 1st tuition plus $25.00
registration fee to Creative Dance Center, 818 CJC HWY COHASSET 02025
(Sorry we do not accept credit cards)
 
Student Name____________________________________
 
Age________________ Date of Birth_______ Grade_____
 
Address_________________________________________
 
Home Tel.#______________________________________
 
Cell/Emerg.#_____________________________________
 
Email___________________________________________
 
Parents/Guardian_________________________________
 
Class day/time desired_____________________________
 
Tuition + Registration fee $ _________________________
 
Allergies_________________________________________
 
WAIVER & RELEASE - You agree that your child is voluntarily participating in these activities and
is assuming all risks of injury that might result.  You hereby waive any claims or rights you might
otherwise have to sue Creative Dance Center, our employees, owners, operators, officers or 
agents for injuries that might occur as a result of these activities.  In case of accident or illness,
you give Creative Dance Center permission to secure medical attention as deemed necessary, if
unable to communicate with you directly.  You also give Creative Dance Center permission to
photograph the registered student for use in any publicity and publication.
 
Parent's Name:________________________________
 
 







Creative Dance Center 3 Brook St.  Cohasset MA 02025 (781)383-2300