2008-2009 School Year Registration Form
Please, print out this form, fill it out and register either by mail or in person at the studio. For any questions please e-mail: rainierballet@yahoo.com or call (425) 277-7460. Please make checks payable to "Rainier Ballet Academy LLC".
(Please fill out one form per student)

Month to register for:   _____________________________________

Class Title:    _________________________________ Day/Time: ___________________

Student's First Name: ___________________ Last Name: __________________ Nickname: _________

Age:________ Birth date: __________ School Grade: ________ School Attending:_____________________

Physical/Medical Limitations: _____________________ Medications: _______________

Allergies: ______________________

They are?
(please circle one)

     Severe       Bad       Mild

The person usually taking me to dance class will be:   Name: ___________ Relation:_____________

Parent's First Name: ____________________ Last Name: __________________

Address:_____________________________________ City: ____________________________

State: _________ Zip: ______________ Home Phone: ________________

Cell Phone(Emerg.): ______________ Emerg. Contact: ______________

E-mail: ________________________ Alt. E-mail: _______________________________

How did you hear about us?     Children Magazine       Friend       Flyer       Phone Direc.      Web Search
(please circle one)

I was referred by:________________________

May we share your Phone/e-mail with other Rainier Ballet Academy parents for our phone tree?

      Yes      No


PAYMENT INFORMATION: Person paying Tuition: _______________________________

Registration Fee: $25 + Class(es) Tuition: $__________ - Discount: $__________


Amount Due: _________ Apply any applicable discount to finalize your "Amount Due"


Rainier Ballet Academy must receive your completed registration form and payment, at least 3 days prior to your child's first dance class.

There are no refunds, credits, extensions or transfers of any tuition


RELEASE AND INDEMNITY AGREEMENT

I undersigned Parent/Student, agree to RELEASE, HOLD HARMLESS AND INDEMNIFY Rainier Ballet Academy LLC and its owners, agents, instructors, staff/faculty, artistic director or any other persons associated with the Rainer Ballet Academy LLC from any and all liability, claims and causes of action arising out of or in any way connected with my participation, or the participation of any minor that I am signing on the behalf of, in any activities offered by Rainier Ballet Academy LLC (including participating in or watching: dance lessons, birthday parties, recital performances, competitions, fundraisers or other activities provided by the Rainier Ballet Academy LLC). I personally assume all direct and indirect risks in connection with these activities. If I am signing on the behalf of a minor, I further agree to HOLD HARMLESS AND INDEMNIFY Rainier Ballet Academy LLC and its owners, agents, instructors, staff/faculty, artistic director or any other persons associated with the Rainer Ballet Academy LLC from any and all liability, claims and causes of action which the minor may have arising from the minor's participation in activities. The terms of this agreement shall serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family, including any minor. (Parents or legal guardians must sign for all persons under eighteen (18) years of age.)

I have read this release and indemnity agreement and have fully informed myself of its contents before I have signed it.

Student Signature:       _____________________________________ Date: __________________
(Parent's/Guardian's signature if student is under 18)