Mini Hip Hop Registration Form
Register and then call the studio with credit card for Payment information
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Dancer's Name *
Dancer's Birthday: *
Parents'/ Guardians' Names: *
Street Address: *
City: *
State: *
Zip: *
Mobile Phone Number: *
Home Phone Number:
How did ypu hear about Fireworks Dance Center?: *
Please note any helath problems, disabilities, or allergies of which we should be aware:
Any previous dance experience? List location, dance styles, number of years, etc:
Is someone in your imediate family (that lives with you) an active first responder( police, firefighter, ems)?
FDC  provides a 10 % Thank you discount off tuition rate to all first responders, military personnel, and Veterans.
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Is someone in your imediate family (that lives with you) an active military personnel or Veteran?
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RELEASE OF LIABILITY *
I understand that dance classes are physical activity. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture, and ask for support from the teacher. I understand that risk of injury is inherent in any physical activity and I knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release Fireworks Dance Center, Inc. and its staff from any and all claims or damages of any kind arising out of my participation in the exercise and/or dance program of Fireworks Dance Center, Inc. I further certify that I am in proper physical condition to participate in the exercise/ dance program and that I have been examined by a licensed physician and found to be in proper physical condition to participate in said program. I hereby agree to irrevocably release and waive any claims that I have now or thereafter may have against Fireworks Dance Center, Inc. or the school’s staff and teachers.
PHOTO RELEASE *
Fireworks Dance Center is given all rights to use photos/videos of me for promotional use.  I give Fireworks Dance Center, Inc. permission to photograph me and to use the photographs around the facility and as a promotional tool.  
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