Please make checks payable to Children’s Dance Workshop and mail this form to:
Children’s Dance Workshop/Dancenter
427 N. Hickory Rd.
South Bend, IN 46615-3562
Check enclosed for _______________
EMERGENCIES Every effort will be made to contact the parent in the event of a medical emergency. If we are unable to reach the parent or guardian, your signature below authorizes Bonnie Boilini Baxter to seek medical treatment for your child. The parent/guardian accepts full fiscal responsibility for said care. I hereby waive for myself, my child, heirs, issues and assigns all claims of liability against Bonnie Boilini Baxter, the Children’s Dance Workshop, instructors, employees, heirs and assigns. PHOTOS We will not identify dancers or classes by name; however, if you prefer that we not use photographs with your child’s likeness, initial here ______
FEES: Payments are due in advance or at the first class. There is never a registration fee. Payment arrangements can be made. Please contact Bonnie if you wish to do so.