3285 Pine Ridge Road, Naples, Florida 34109 Phone (941) 593-8280 Fax (941) 593-8284 To register a Child, go Here. Adult Class Registration Form Name (last, first, middle) Sex Address City State Zip Code Home phone Email address What class or classes do you wish to sign up for? Some classes may be full and no spots will be held for any class until payment is made in full. In the Event of emergency notify: Name Phone Business phone Do you have any allergies or medical conditions of which we should be aware? Yes No If yes, please describe: Waiver of Injury - Please Read I do hereby voluntarily submit my child and/or myself for attendance and participation in the Etudes de Ballet & Co. dance and other programs and do hereby assume full responsibility for any and all damages, injuries or losses that she/he/I may sustain or incur in anyway while attending or participating in any Etudes de Ballet & Co. classes or activities both in and away from the studio. I, the undersigned, do hereby waive all claims against the instructors, owners and/or operators, individually or otherwise, of Etudes de Ballet & Co. or J.D. Burt Company, Inc., for any injuries she/he/I may sustain while attending or participating in said programs, I fully understand that any medical treatment given to my child or myself will be for first aid only, but I give emergency treatment authorization if I cannot be reached. This form can be photocopied for emergency treatment. I agree with the above waiver. Yes No No Refund Statement Etudes de Ballet & Co. has a strict policy of no refunds for any reason. 12/14/2006
To register a Child, go Here.
Adult Class Registration Form
No Refund Statement Etudes de Ballet & Co. has a strict policy of no refunds for any reason.
12/14/2006
