Photo taken by Kaitlyn Ihn STUDIO ONE FALL REGISTRATION FORM   **NEW STUDENTS: before registering please contact Ms. Kelly to discuss classes! ** RETURNING STUDENTS: Please note, if you are registering for a class that is HIGHER than the recommended level, please contact Ms. Kelly to discuss the class! When placing students, we are recommending what is best for YOUR dancer!   Student's Name(one per form):                                     Date of Birth:                     Age:       Address:                                              City:                 Zip:               PARENT/GUARDIAN INFORMATION: Name:                                                           E-MAIL Address:                                       Home Phone:                            Cell:                              Emergency Contact:                                    Phone:                      When choosing a class, be sure you have an alternate class in mind if class is full or has low enrollment. Class Title:                                         Day:               Class Title:                                         Day:               Class Title:                                         Day:               Class Title:                                         Day:               Class Title:                                         Day:               Class Title:                                         Day:               Alternate Class Title:                               Day:               Alternate Class Title:                               Day:                 ADD FALL Registration Fee (Per Family):$15.00 (Registration Fee and Tuition is required for processing) Total Enclosed: (with registration fee) In the space below please let us know if your child has any special medical needs, learning behaviors, or physical limitations so we can teach in the best way possible, please note this is STRICTLY CONFIDENTIAL:

Studio One Dance Company Release and Parental Agreement By signature of this waiver and agreement, I understand registration, classes are non-refundable, non-returnable. Credit is applied to my account for class refunds only.  I give Studio One Dance Company, LLC permission to have my child or children enrolled in dance class, while fully aware risks are involved as in any other sport. I agree Studio One Dance Co. and it's staff will not accept responsibility for injuries sustained during dance classes, performances, conventions, and competitions. I hereby authorize Studio One Dance Co. staff to assist with temporary first aid to my child or children in the event of any illness and seek medical aid in the event of an emergency. I understand I am responsible for medical expenses incurred through illness, accident, or injury. I have read and understand the above statement. I have provided complete and accurate information to the best of my knowledge. Further, I realize Studio One Dance Co. and it's staff are not held liable for any loss, illness, accident, or injury sustained by my child or children during their time at Studio One Dance Company, LLC. **Studio One Policy: All Registration and Class Fees are non-refundable and non-returnable. In case if class absence, student may make up their class.  Refunds and tuition adjustments in the case of student absence is not available.  Parent/Legal Guardian Signature Date

Checks Payable to Studio One Dance Company, LLC Mail Checks to: Studio One Dance Company, LLC Attention: Kelly Heis 543 AJ Allen Circle, Suite H Wales WI 53183 (262) 968-1820

Photo taken by Kaitlyn Ihn