Brandi Rae's School of Dance - Registration Form

Brandi Rae Lochiatto
(508) 875-2723

Untitled Document

REGISTRATION FORM Fall 2011 / Spring 2012 TO REGISTER: MAIL COMPLETED FORM TO: Brandi Rae's School of Dance, 116 Cochituate Rd, Framingham MA 01701 Checks Payable To: Brandi Rae Lochiatto ONE FORM PER STUDENT
FALL 2011-Session I SPRING 2012-Session II
Student Name Age Birthdate
Class/Day/Time	Class/Day/Time



Parents/Guardians		Total Hours Per/Wk
	Total Amount
	Registration Fee
	(DISCOUNT IF APPLICABLE)
	Grand Total
Billing Address
City State Zip Code
Home Phone Work Cell
Email
Emergency Contact Emergency Phone
Allergies/Medical Conditions/Special Concerns
Signature Date
I have read and understand Brandi Rae's School of Dance Policies and accept all financial obligations. For information see website www.brandiraesschoolofdance.com. LIABILITY DISCLAIMER: BRANDI RAE'S SCHOOL OF DANCE AND ITS INSTRUCTORS ARE NOT LIABLE FOR INJURIES THAT MAY OCCUR DURING THIS ACTIVITY AND ARE NOT LIABLE FOR LOSS OR DAMAGE TO PERSONAL PROPERTY. PARENTS/STUDENTS ARE RESPONSIBLE TO INFORM INSTRUCTORS OF ANY LIMITATIONS, PROBLEMS, MEDICAL NEEDS, OR CONCERNS.