Adults Salsa On2 Dance Classes!

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917-215-1720

Addie@Addie-tude.com

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Addie-tude Kids Registration Form

Today's Date

Students Name

Student's Address - Include: Street Address, City, State & Zip

Child's Birthdate

Choose Online or In-Studio Classes

Onsite classes / In-Studio Dance

Virtual Classes / Online at Home

Hybrid: Both In-Studio and Virtual (will request a spot in class when ready)

Type of Class Attending (Choose 1 or More Classes)

WED HIP-HOP MINI'S - Ages 3-5

WED: Kids Beginner BALLET - Ages 7-12

WED: INTRO TO BREAKDANCING - Ages 6-11

WED: HIP-HOP Kids - Ages 6-12

WED: Kids LATIN Dance Combo Class (Salsa, Bachata, etc.) - Ages 7-12

FRI: Kids LATIN Dance Combo Class (Salsa, Bachata, etc.) - Ages 7-12

FRI: Kids Beginner BALLET - Ages 7-12

FRI: Teen LATIN Dance - Ages 13-18

SAT: HIP-HOP MINI'S Ages 3-5

SAT: Little Dancers BALLET/HIP-HOP Combo Class Ages 3-5

SAT: Little LATIN Dancers Combo Class (Salsa, Bachata, etc), Ages 4-6

SAT: Kids BALLET - Ages 7-12

SAT: Intro to BREAKDANCING - Ages 6-12

SAT: HIP-HOP Kids Ages 7-12

SAT: LATIN Kids Combo Class (Salsa, Bachata, etc.) Ages 7-12

SAT: Kids WEST AFRICAN DANCE - Ages 7-12

SAT: Teen HIP-HOP - Ages 13-18

SAT: Teen LATIN Dance - Ages 13-18

SAT: Teen WEST AFRICAN Dance - Ages 13-18

Child's Tshirt Size

Child X-Small 2-4

Child Small 6-8

Child Medium 8-10

Youth Large 10-12

Youth X-Large 14-16

Youth XX-Large 18-20

Adult Small

Adult Medium

Adult Large

Adult X-Large

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Parent/Guardian #1

Contact Info

Optional: Emergency Contact #2 - Name & Best Number

Parent/Guardian Mobile Number

Parent/Guardian Email Address

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2nd Parent/Guardian Info (Optional)

Parent/Guardian Name

Parent/Guardian Mobile Number

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Liability Waiver and Release

LIABILITY WAIVER AND RELEASE: I attest as the legal parent or guardian, that the participant is physically fit to partake in Addie Diaz’s dance class. I acknowledge that the participant is dancing at his/her own risk and by signing this waiver; I release Ms. Addie Diaz and Addie-tude Productions, Inc., DBA: Addie-tude Cultural Arts Center from all claims on account of any injury, which may be sustained during dance class. I recognize that I am responsible for the participant’s personal possessions and will not hold Ms. Addie Diaz and Addie-tude Productions, Inc., DBA: Addie-tude Cultural Arts Center responsible for any damage or theft.

I've read the above Studio Policies and AGREE.

I've read all of the above Studio Policies and DO NOT Agree.

REFUND PERIOD: If your child cannot complete the course, you may receive a refund, minus any previous class taken. BUT you MUST ask for that refund no later than the third class (3rd wk) of paid tuition.The studio reserves the right to combine age group or cancel classes that do not have minimum enrollment.

I've read all of the above Studio Policies and AGREE.

I've read all of the above Studio Policies and DO NOT Agree.

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EMERGENCY HEALTH INFORMATION

Does your child have any restrictions or limits on physical activity? If yes, please explain. If no, type in N/A

Does Your Child have Allergies (including Food)? If yes, please explain. If no, type in N/A

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Authorized Pick Up

Person authorized to pick up your child in your place.

Please List all people who are authorized to pick up this student:

Thank you for contacting us.
We will get back to you as soon as possible.

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Text or Call: 917-215-1720 Email: AddietudeArtsCtr@gmail.com

CORTLANDT MANOR

At: Parkside Corner Plaza

On My Toes Dance Academy
3565 Crompond Road

Cortlandt Manor, NY 10567

MOHEGAN LAKE

At: Argyros Plaza

Star Struck Dance Studio
1906 E Main Street

Mohegan Lake NY 10547

PLEASANTVILLE

Home Studio
Downstairs: Ground Level

Addie-tude Cultural Arts Center
42 Memorial Plaza

Pleasantville, NY 10570

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