Registration Form 2024-2025 Student Information Student’s Name Birthday Home Phone Student Cell Student Email School Address City State Zip Allergies we should be aware of Pre-existing injuries/disabilities/medications Parent(s)/Guardian’s Info Parent/Guardian #1 Name Cell Home Work Email Parent/Guardian #2 Name Cell Home Work Email Emergency Contact Information First Emergency Contact other than a parent/guardian Please specify relation to student Cell Home Work Email Enrollment Information Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 Class 8 Class 9 Class 10 Class 11 Class 12 Terms and Conditions By participating in The Pretenders Studio, Inc. classes/programs, the student (or parent/guardian) assumes any and all risk of injury. Student (or parent/guardian) agrees by signing this release not to make any claim against Lisa Gumenick, The Pretenders Studio, Inc., Dance for A Difference Inc., the instructors and staff members, any guest instructor, or any affiliated organizations of The Pretenders Studio, Inc., 1444 9th Street Property LLC, Altemus Company, any and all rehearsal venues, or performance spaces, for any injury occurring as a result of their child’s (or their own) participation in the program, class, rehearsals or performances. In addition, participant, parent/guardian, releases and discharges Lisa Gumenick and her related organizations and instructors from all actions, claims, or demands that the participant, parent/guardian, now or in the future, may have for any injury resulting from participation in the classes/programs/rehearsals/performances. I have read, understand, and agree to all of the policies, expectations, showcase info and dates, release of liability, and terms and conditions above. Parent/Guardian signature required: All Students/Participants must sign: Date: Submit