Fabulous Feet Dance Studio Registration Form

Parents Names: ______________________________________________________

Student Name: _______________________________________________________

Address: _____________________________________________________________

Phone: ( ) ______________________

Emergency Contact: _______________________ Phone: ( ) _______________

I ASSUME AND FABULOUS FEET DISCLAIMS LIABILITY FOR LOSS OR INJURY SUSTAINED BY STUDENT ON THE PREMISES.

Signature of parent or guardian ______________________________________________________

Paid by check Paid cash

Please mail or bring form and a $20 registration fee to

Fabulous Feet Dance Studio

3901 Walnut Blvd.

Brentwood, CA. 94513

925-634-4399