Hudson Valley Academy of Performing Arts Student Registration Form

Please print and complete one form for each student.

Student Name______________________________________________________   Female   Male

Address_______________________________________________________________________

City__________________________________________    State_________    ZipCode___________

E-mail___________________________
May we send you notices about events, specials, etc?    Yes    No

Emergency Contact Name___________________________________________________________

Phone(____)________________    Relationship to Student________________________________

Age________    Birthdate____/____/_______     Parents names_______________________________

Phone Numbers:
Home(____)________________    Work(____)________________    Cell(____)________________



Class Name & Level______________________________________________________

Day & Time_______________________________________________________________

Additional Classes________________________________________________________

Method of Payment:

Annual Registration Fee: $15 additional $20 family rate

Annual Tuition: 10 month commitment Sept-June: 35 weeks of classes

Monthly (4 monthly payments per semester)__________    2 Payments____________    Single Annual Payment___________



Name of parent or person responsible for payment______________________________

Phone/Contact Info_______________________________________________________

Release of Liability:

Students and/or Parents of students understand and expressly assume all risk involved in connection with dance or other instruction, rehearsal, and training at Hudson Valley Academy of Performing Arts, including but not limited to risk of bodily injury occurring as a result of contact with other students, instructors, walls, equipment, floors, and other objects located in or near dance studios, or the Student's physical condition or physical limitations, and the student warrants that they are physically able to participate in all activities involved in dance and other instruction, rehearsal and performance and assume the risk of such. Students waive all claims arising out of dance or other instruction, rehearsal, and performances at Hudson Valley Academy of Performing Arts, whether caused by negligence or otherwise, and whether for bodily injury, property damage, or loss or otherwise, which Students and/or Parents may ever have against Hudson Valley Academy of Performing Arts, its successors, and assigns, and its owners, officers, directors, shareholders, employees and agents, and their heirs, executors, and administrators.

Release of Liability- Signature_______________________________________Date_____/______/_____________