Register & Payments

American Academy of Performing Arts Co.

Registration 2009-2010

Registration forms are required for each individual student. Please write legibly.

Students Full Name: ____________________________________ Date of Birth _________ Age (as of 9/09)____ ______

Home Phone: ________________________ __Email (required for communication) __________________________________

Address _________________________________________City ___________________ State ______ Zip ____________

Name of Academic School ________________________________________________________ Grade _____________

Mother/Parent/Guardian #1 _____________________________________Work Phone #_________________________

                                                                                                                                              Cell Phone # _____________________

Father/Parent/Guardian #2 ______________________________________Work Phone #_________________________

    Emergency contact (if different from parent’s cell phones)                                         Cell Phone # _____________________

Name ________________________________________________________ Phone # ____________________________

For New Students Only

Previously Trained with __________________________________________ How long? ______________ years

2009-2010 Class Schedule

Please include all requested classes in the schedule below, listed in order of first choice and so on.

Sample: Class ___Intermediate Ballet________ Day __Tuesday & Thursday__ Time __7:30-8:45 pm

                Class _______________________________Day ___________________________ Time _________________

                Class _______________________________ Day ___________________________ Time _________________

                Class _______________________________ Day ___________________________ Time _________________

Every student receives an AAPAC logo T-shirt with paid registration. Please circle student’s size which we will order.

Girl’s sizes: S(6-8) M(10-12) L(14-16) Women’s sizes: S(2-4) M(6-8) L(10-12) Boys sizes: S(6-8) M(10-12) Men’s sizes: S, M, L, XL

Student Directory

Would you like to be included in the Student Directory? This is updated each fall. The information contained in the directory is for the use of students and their parents. The directory will list: Name of Student, Dance Level, Address, Home Phone Number, Parent’s E-mail Address, Name of Mother, Name of Father. The directory is a useful tool for carpooling, volunteering and play dates. Please note that you WILL be listed if you leave this section blank.

( ) List all the information in the Student Directory

( ) Do not list any information in the directory

( ) List only the following information (circle ones that apply)

Name of Student    Dance Level            Address   Home Phone Number             Parent’s E-mail Address

Photo Permission

Occasionally we like to use student’s photographs from classes or performances in our brochures, flyers, or on the web site. Please sign below if you give us your permission to use your child’s photograph.

I give American Academy of Performing Arts Co. permission to use my daughter/son’s photograph(s) in publications and/or on the website.

2009/2010

Must be signed for student to participate in classes and performances. Please read carefully before signing.

I _______________________________________________, the enrolled participant and/or the parent/guardian of the participant

agree and understand that dance/fitness training is a potentially hazardous activity. I recognize that there are risks inherent in dance

training including, but not limited to, serious physical injury. The participant hereby agrees to participate in activities of the American Academy of Performing Arts Co. of Oregon and hereby agrees to indemnify and hold harmless American Academy of Performing Arts Co, its instructors, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in activities of the American Academy of Performing Arts Co. The participant also agrees to indemnify American Academy of Performing Arts Co. for any damages incurred arising from any claims, demand, action or course of action by the participant. The participant authorizes any representative of American Academy of Performing Arts Co. to have the participant treated in any medical emergency during their participation in activities of the American Academy of Performing Arts Co. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

 Any special medical/health/social problems or needs of which the staff should be aware are outlined here (please include any learning disorders, autism, ADD, ADHD, Asbergers, allergies and previous injuries):_________________________________________

____________________________________________________________________________________________________________

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENT AND

SIGNIFICANCE. ADDITIONALLY, I HAVE READ AND AGREE TO ABIDE BY ALL STUDIO POLICIES AND PROCEDURES.

____________________________________________________________________

Student’s Name (please print)   ____________________________________________ Signed Date _______

Parent/Guardian (if participant is under 18) (please print) _________________________Signed Date _______