Home      Registration Form
Classes begin September 11
Fill out information below, print and mail with 1st tuition plus $25.00 registration fee to South Shore Community Center PO Box 631, Cohasset 02025  
(Sorry we do not accept credit cards)
Student Name____________________________________
Age________________ Date of Birth_______ Grade_____
Home Tel.#______________________________________
Class day/time desired_____________________________
Tuition + Registration fee $ _________________________
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 (781)454-6724  
South Shore Community Center
3 North Main St., Cohasset

Hingham Community Center