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Registration Form

Document
Printable version of Registration From
Bodiography Center For Movement 2009-2010 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___________________________________
   
 Bodiography Contemporary Ballet   5824 Forbes Ave   Pittsburgh, PA  15217  412.521.6094
 © 2010
Bodiography
All Photography © 2010 Eric Rosé