Bodiography Center For Movement Registration Form
Name_______________________________
Address_____________________________
City, State, Zip_______________________
Phone_______________________________
E-Mail (We are going GREEN!)_____________________
Register For
Class_________ Day________ Time______
Class_________ Day________ Time______
Previous Experience________________________
Parent’s Name__________________________________________
Phone_________________________________________________
Emergency Contact______________________________________
Phone_________________________________________________
Allergies/Physical Acknowledgements______________________
With this signature I release Bodiography Center for Movement including its instructors, directors, and administrative staff from any and all liability concerning physical injury-damage-loss of property. This signature also grants unlimited permission and releases all rights for my child/myself to participate in any media efforts on behalf of Bodiography Center for Movement and Bodiography Contemporary Ballet. If a student should become injured it is at the discretion of the faculty to decide the appropriate participation during future class time.
Signature___________________________________
