Robin Dawn Academy Online Registration

Registration

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Hi! We are so excited you want to register your dancer for classes at Robin Dawn Academy! If they have taken a trial class with us please put the name of the trial class in the comments section and we will get them registered. If they have not done a trial class please list the type of dance classes they are interested in and any experience they might have. We will contact you to schedule a trial class. You can visit our website for our current class schedule at robindawnacademy.com

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Add Another Student

Required Policies and Agreements

AGREEMENT FOR PARTICIPATION

I understand the physical nature of the dance classes and that injuries could occur to my child. I accept full responsibility for the care and/or treatment of such injuries sustained by my child through participation in the classes and performances.
I am aware that if my child is working on the circus equipment or other apparatus at the studio or on location, I am responsible for treatment of injuries sustained by my child. I understand manual adjustment of a student's body to correct alignment and technique is standard practice.

I've read the above and agree.

Release and Hold Harmless

I hereby agree to release Robin Dawn Academy, Inc., Robin Ryan and all employees, teachers, and agents of said dance studio from any and all claims for liability that could be asserted for any and all injuries sustained or suffered by me during any local or out of state rehearsal, performance, or competition. I further agree to hold above Robin Dawn Agents harmless of any claims that might be asserted as a result of any injuries sustained by me.

I've read the above and agree.

Photo and Video Release Form

I hereby consent that any photos/videos taken of my child may be used by Robin Dawn Academy, Inc. for publications, public relations, advertising and any other purposes it sees fit without further consideration from me. Including all social media outlets.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments