Student Name(s):
Email (He):
Email (She):
Street Address:
City, State, Zip:
Phone:	Home Work (He) Work (She)
Birth Dates (Month & Year)	(He) (She)
Physical Injuries or Disabilities if any:
Previous Dance Instruction and When:
Class I (we) are enrolling for: Second Choice:
How did you hear about "Dance With Me!":	Google/Internet search Superpages Newspaper DCDanceNet Word of mouth Other If Other, please specify:
Best nights and times for your classes:
Reason for Taking Dance Lessons:
Security Code:

I understand and agree that all group classes that are canceled 5 days before they start, will get you a refund of 1/2 of the registation fee. Prior to that you get a full refund. There are no refunds for canceling a class the day class starts or any time after that, during or after that session. Another class can be taken instead of the class you wish to cancel but only in the session you are canceling. Privates must be taken within 3 months of the purchase date. After 3 months any remaining privates that are not taken will be void. No refunds, exchanges or extension will be given. Anyone purchasing the 4 privates discount package must take all privates within 3 months of their purchase and they cannot be exchanged or credited in any way. They will be paid for whether they are taken or not. I/We also agree that I/we will participate in classes and functions sponsored by "Dance With Me!" Ballroom Dance Studio at my/our sole risk and that the Studio shall not be liable for any injuries or any damage to me/us or any guest or the property or any student or guest, or be subject to any claims, demands, action, causes of action, or damages whatsoever, I/we, for myself/ourselves and on behalf of executors, administrators, heirs, assigns, and successors, hereby expressly forever release and discharge the Studio, its owners, employees, agents, assigns and successors from all such claims, demands, injuries, damages, actions, or causes of action. The Studio shall not be responsible or liable to guests, or me/us for articles damaged, lost or stolen in or about the Studio, including but not limited to cars and the contents thereof.

I agree to the Terms of Service