NOTE: ALL  Classes Are Grouped By Age, Type  of Class, & “Impossible” Day/ Time Info. listed  here plus Date Your Dance Reg. Form w/ Payment Is Received

IMPOSSIBLE DAY/S and/or TIMES/S:_________________________________________________________________

Ø              “BEFORE 3PM”  PRESCHOOL/PRE-K & HALF-DAY K , (or Other) –See  Schedule of  Pre-K Day/s &  Time/s on Pg. 2

Child Turning  3 in Summer or Fall  ’08 May Register for:  “Fall Dance for  Parent (Caregiver) & Child ”  &/or  Winter/Spring  “Tiny Ballerinas”  (for  dancer only)

   “AFTER 3PM” FULL-DAY K THRU HIGH SCHOOL (M-Thurs; Gr. 5 and Under -Afternoons; Middle & High School-Eve.) Unlike the Preschool/Half-Day K Dance Schedule, the After 3pm  Dance Schedule is not pre-determined, and  may vary from yr to yr.  to  reflect the ever changing  needs of  the majority  who register  Before July 15  (Type of Class & stated Impossible Day /Time info, & the Date that Reg.. and Payment are rec’d).

Child's Name: ___________________________________Age: ____ Birth mo/day/yr: _______/________/_____

'08-'09 School: ______________________________'08-'09 Grade: ______ PRUMC Member? Yes_____ No ____

 Home Address: __________________________________ City:_____________________  Zip: ______________

 >List pertinent health info on separate page & attach: allergies, asthma, required medications, learning problems, etc.

Mother's Name: ________________________________ Home Phone No. (          ) _______________________

Mom's Cell No. (          ) __________________________ Mom's Work No. (          ) ______________________

Father's Name: ___________________________________Dad's Work No.  (          )________________________

Dad's Cell No. (          )______________________________FAX (location): _______________________________

PLEASE PRINT:  Family Email:_______________________________________________________________

   > Please keep your contact info updated in case of emergency! 

    > If billing address is different, please attach a note clearly stating  your needs.

 > No Refunds for missed classes; make-ups for prolonged illness/injury by appt. only-where space is available.

>May a photograph of your child be used for publicity if she/he is not identified by name? Circle:  Yes   No       

DANCERKIDS CALENDAR NOTE:

Dance Program Dates MAY Differ by Age/Class, and MAY NOT match the calendar of ANY school, including PRUMC Preschool,  other Recreation Programs, or other Dance Studios.  Be sure to get a DancerKids, Inc. Calendar at your first class and keep anyone who drives your child updated.  IF a Driver other than the Parent must pick up your child after Dance, be sure to give the Dance Teacher the Driver’s cell phone number in advance of the class, and a number where Parent can be reached.

v           TO COMPLETE  DANCE REGISTRATION-Sign & Date “Release” (Pg.  2 or  On Reverse), attach to this Form!

v           Mail with Tuition Payment (Listed on Pg 2) to:  “DancerKids, Inc.”, 400 Elden Dr. , Atlanta, GA 30342

SIGNED RELEASE Must be Attached to Pg. 1 /DancerKids Registration Form for Registration to be Accepted:       (Pg. 2)

WAIVER OF LIABILITY AND RELEASE:

I recognize that there are inherent risks involved in dance and fitness activities. In consideration of the services provided, I hereby release and hold harmless, DancerKids, Inc., Peachtree Road United Methodist Church, and its Department of Sports, Recreation and Life Enrichment and both organization’s Directors, employees and agents from any and all liability for injuries, including those resulting in death, and illnesses incurred while participating or attending any event or in any facility of Peachtree Road United Methodist Church. By signing this document, the adult participant, or parent or legal guardian of a child participant confirms that he or she has authority to sign, has read the entire document, and has understanding that the document waives certain rights of the person signing or the participant.  >Sign Release and MAIL check with this form to: DancerKids, Inc.,  400 Elden Drive, Atlanta 30342

        Print Parent's Name:_______________________________________________________________________________________________

Signature: __________________________________________________________   Date: ____________________________

Please List Your Check No:__________________________ Payment Amount: __________________________________________

FOR DISCOUNT TUITION:  1) DancerKids Registration Form, with 2) Signed and Dated Release, and a 3) Check for Either Full or One-Half the Annual DiscountTuition, must ALL be MAILED TOGETHER and POSTMARKED On or Before May 31, 2008!   MAIL To: “DancerKids, Inc”- 400 Elden Dr. NE Atlanta GA 30342.