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Summer 2017

Last Name: (Parent / Guardian if registrant is under 18)(*)
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First Name: (Parent / Guardian if registrant is under 18) (*)
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*Initials (Parent / Guardian if registrant is under 18)(*)
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Street Address:(*)
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Street Address 2:
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City:(*)
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Phone Number:(*)
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Alternate Phone
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Students Name:(*)
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Students Birth Date:(*)

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Monday Classes:

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Tuesday Classes:

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Wednesday Classes:

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Thursday Classes:

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Summer Specials
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Health Concerns:
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Today's Date:(*)

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How did you hear about Dance Works?
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I hereby release the Directors, their Agents, and Employees of Dance Works and the premises upon which the class is being conducted, from all claims for damages regarding loss of property, accident, or injury sustained during or in connection with said class. I also understand there is absolutely no refunds on any dance classes. By clicking the I accept Check Box you are Digitally Signing that you agree to these terms.(*)

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By Clicking I accept you are digitally signing and agreeing to the following: By enrolling (person)/the minor in this course, I/We certify that I/We am/are aware of the possibility of injury in connection with the activities connected therewith. I/We understand and agree that neither the owners, agents or instructors, including by not limited to Kathleen Johnston, may be held liable in any way for any occurrence in connection with the dance studio which may result in injury or other damages to the minor, me/us of the minor's family or heirs or assigns. In consideration of the minor being allowed to enroll in this course, I/We hereby personally assume all risks in connection with the course, and I/We further release the instructors, program, agents, and operators, including but not limited to the person mentioned, of any injury or damage which may befall the minor while the minor is enrolled as a student of the school, including all risks connected therewith, whether foreseen or unforeseen; and further, to save and hold harmless the program and persons from any claim by or on behalf of the minor of the minor's family, estate, heirs, or assigns, arising out of the minor's enrollment and participation in this course. I/We further state that I/We am/are of lawful age and legally competent to sign this affirmation and release; that I/We understand the terms herein and contractual and not mere recital; and that I/We have signed this document as my/own free act. I/We have fully informed myself/ourselves of the contents of this affirmation and release by reading it before I/We signed it.(*)

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By Clicking I accept you are digitally signing and agreeing to the following: I hereby grant Dance Works of Quakertown PA permission to use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Dance Works and will not be returned. I hereby irrevocably authorize Dance Works to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Dance Works? programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Dance Works from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 years of age or am a legal guardian and am competent to contract in my own name or my child's name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.(*)

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In compliance with studio policies all classes are subject to approval by the teacher and studio. Your registration will not be complete until classes have been approved.
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Contact Information

Dance Works
850 North West End Blvd.
Quakertown PA 18951
(215)536-8090
.