GUIDELINES / POLICIES DRESS CODE Covid-19 Contact Us Dancer Information First Name Last Email Phone Date of Birth Age Grade Preschool Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th grade 9th Grade 10th Grade 11th Grade 12th Grade Medical Conditions Parent/Gardian Info Parent/Guardian Information Parent/Guardian Name Last Email Home Phone Cell Phone Work Phone Address Address2 City State AL AK AS AZ CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY Zip Code Mailing Address if different MalingIfDiff MailingIfDiff2 City State AL AK AS AZ CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY Zip Code Emergency Contacts Emergency Contacts Name Last Name Phone Cell Emergency Contact 2 Name Last Name Phone Cell Additional Emergency Contacts Tuition/Classes Class Registration Monthly Tuition One Class $85.00 Two Classes $160.00 Three Classes $235.00 Four-Five Classes $300.00 Class Options Monday Min Ballet Ages Tuesday Mini Jazz Ages Wednesday Childrens Movement Saturday Mommy & Me Saturday Mini Ballet Registration fee $15.00 Registration fee Referred By Terms of Service Rules and Regulations of NMDStudio and Masjah Studio: I take full responsibility for myself and my Dancer in class and/or on studio grounds. I take full responsibility for any loss or damage to my property or affiliates property while on studio grounds. I take full responsibility for any bodily injury which may occur in class or on studio grounds. I have read all NMDStudio & Masjah Studio’s Covid Rules and Procedures, and understand that I, my dancer, and any guardian etc. that may enter studio grounds must abide by these rules. I understand, If an event occurs, where the Government orders a Mandate shutdown, all classes will switch to remote, and your payment will cover the month of class(es) your dancer is registered. I understand that NMDStudio, Masjah Studio and it’s affiliates prohibits drinking/smoking/drug use in or on studio grounds and property. I release NMDStudio, Masjah Studio and its Affiliates from any loss, damage or injury. I Authorize NMDStudio and it’s staff to bring myself or the child to the nearest medical facility if the need arises. I give NMDStudio and affiliates permission to use my child or mine photo in any print,advertising, or social media. I understand there is a registration fee of $15 for single dancers and $30 for a Family for all dancer’s and due when signing up my dancer or myself. I understand that if the fee is not paid my child’s spot or mine will not be held and my dancer or I can not participate in class. I have read and understand the Covid Regulations(see attached rules and regulations page) . I understand I Must sign in and out with the Teacher or Front desk staff upon arrival and departure. I understand if there is another parent/guardian, friend etc, picking up my child I must let the teacher or front desk staff know and the person must also sign in or out depending on the situation. I understand I must give NMDStudio a 2 week warning if my child is dropping a class. I understand that if my dancer is dropping a class I must submit a 2 week warning or I will be responsible for the next month’s tuition. I have read and understand all rules and regulations listed above for NMDStudio and Masjah Studio and its affiliates Agree check this box to agree to the REGISTRATION TERMS & CONDITIONS Sign Send