Kehl Dance Registration Form

Please complete the registration form. Fields marked * are required.

Please email us or call at (608) 829-2003 if you have any questions regarding this form.

* Location Preference
* Student Name
* Address 1
Address 2
* City * State
* Zip    
* School * Grade
* Birthdate
* Age
* Dance Experience
Cell Phone
Email Address
       
Desired Courses Refer the Madison, Verona, or Wannakee schedule for course availability. Please type in the course in the box below.
  * * Day & Time
  Day & Time
  Day & Time
       
* Mother's Name
Place of Work
* Phone
(h) 		Phone (w)
Father's Name
Place of Work
Phone (h) Phone (w)
       
* Method of Payment
If you select Check, you will be presented with an address to mail in your registration. You are not registered until payment is received. Thank you for your business! 		*Amount
       
Terms

AGREEMENT TO PARTICIPATE AND LIABLITIY WAVIER: I understand dance and related activities involve risk of injury. I agree I will not hold Kehl School of Dance, LLC, (it’s owners, staff and related parties) responsible for injuries/damages incurred by any of my family members while participating or visiting facilities. AUTHORIZATION OF MEDICAL CARE: In case of injury or illness while participating, I authorize medical care for my child and accept responsibility for medical expenses. POLICIES AGREEMENT: I have read, understand and will abide the policies set forth by Kehl School of Dance, LLC, including no refunds on tuition or costumes paid.

Electric signature box - Please type in your name.

  * I have read and agree to the above terms.