A Piedi Dance Company

Weekday Warriors Registration Form

May 2011
Name: _________________________________________ Phone: _________________
E-Mail:_________________________________________ Cell phone: ______________
Address ________________________________________________________________
City:_______________________ State:_____________ Zip code:__________________
Please register me for the following class
Day of Week: _____________________________, 6 month Block: __ or 2 month session: __
Please make checks payable to A Piedi Dance Company

Tuition is due on the first lesson of each month. Partial payments will NOT be accepted. Students with
outstanding balances will NOT be admitted into the class.
I would like to enroll in the Weekday Warriors Program at A Piedi Dance Company. I agree to pay
$__________________ per month, Due on the first class of each month.

 There will be no class re-assignments after the session has begun.

 There will be no refunds, or credits for missed lessons. Students may make up any missed lesson in a
similar class. Make-ups need to be scheduled in advance.
 The studio is closed for Labor Day, 4th of July, Thanksgiving Break, Winter Break, and Spring Break,
 We reserve the right to display any team and/or individual photographs.

I hereby agree to participate in dance training and dance classes programs (the “Programs”) at A Piedi Dance
Company, at its place of business and any and all other locations provided by A Piedi Dance Company, for its
programs. We understand that dance training and classes are associated with physical exercises, jumping, rotation of
the body, limbs, and head, stretching, and the like, and that there are risks involved as a result thereof.

On our own behalf, I indemnify and hold harmless, and waive all claims against A Piedi Dance Company, its
principals, agents, servant, and employees from and against any and all loss, cost, charge, claim, demand, liability,
damage, medical expenses, long or short term care, future, arising directly or indirectly from any personal injury or
property damage loss, including, but not limited to partial or total disability, paralysis, or death, which may occur to
my person while on the premises of A Piedi Dance Company or any other location provided by A Piedi Dance
Company and/or under instruction, supervision, or control of A Piedi Dance Company.

□ I have read, understand, and agree to all above stated terms (please check).

_____________________________ __________________
Signature Date

______________________________ __________________
Signature Date