THE Only place for DANCE in Middle TN!

Application for Registration 2008-09 Season Print Friendly Version

Student’s Name _____________________________________________________________________________________

Parent’s Name ______________________________________________________________________________________

Home Address _______________________________________________________________________________________

____________________________________________________________________________________________________

Home Phone (____) ___________________Work (mom or dad, which?)(____) ___________________
Birth date _______________________________Age __________________

Referred to “Artistry In Motion” by; _______________________________________________________________

Email address (for newsletters, etc…if you like)____________________________________________________

Please list for us the areas of dance you have studied and for how long? ___________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Where have you studied dance? ______________________________________________________________________
Where do you attend school? ________________________________________________________________________
School is out by what time everyday? _______________________________________________________________
Preschoolers, what day do you go to school? _________________What hours? ___________________________
Classes Desired – Please mark all that apply. Summer_______ Fall_____ Both__________
Ballet ______ Pointe _____ Pre Pointe (Summer__)Tap______ Jazz_______
Acrobatics_______ Modern_____ Lyrical Technique________ CORE/Strength_______
Hip Hop ________ Adult level class_____________

Summer “Dance Max & Mega Max!!” Aug 4th-8th & 11th-15th (ages 8 through adult) _______________________________

Tell us the days of the week you CAN NOT attend class_________________________________

Does this student have any special needs or medical conditions we should be aware of? ______________________________________________________________________________________
If so, what are they? ____________________________________________________________________________

I am interested in my child auditioning for “N2M”, our dance performance troupe ___________.
I would be interested in your “Teacher in Training” program (Starting new session fall 2008) ______________.

Emergency Contact and or parents cell number______________________________________________________
Person responsible for account (and address if different from above)_________________________________________________

*I understand that any type of dance and acrobatic study encounters certain physical risks. By signing below I am agreeing to allow myself and or my child to participate in “Artistry In Motion’s” program. I will not hold the owners or any staff member at “Artistry in Motion” responsible for any accident or injury that could occur. Furthermore, I agree to the operational policies of the studio, which includes being responsible for my account and paying this account in the manner outlined in the studio policies.

Signature of parent or legal guardian
__________________________________________________________ Date______________
Please enclose the registration fee to ensure proper processing of your application.
We look forward to providing you the “best” in quality dance education.
Mail to: Artistry in Motion, PO Box 291024 Nashville TN 37229-1024

Registration fees received ( ) Check number______ $20 for first dancer,
$10 for each additional in family.
Now Accepting MasterCard, Visa, Discover and American Express Credit cards
for all of your account transactions.