Class Registration | Bella School of Dance

Parent / Guardian Information

Mother / Guardian 1 Name * Please enter a name

Cell Phone * Please enter a cell phone number

Father / Guardian 2 Name

Cell Phone

Family Email * Please enter a valid email

Home Phone

Home Address

City

State

ZIP

Emergency Contact

Emergency Contact Name * Please enter a name

Emergency Contact Phone * Please enter a phone number

Additional Information

How did you hear about Bella?

What made you decide to come?

Preferred Payment Option *

Agreements

I, the undersigned adult or legal guardian, recognizing that classes involving physical activity may result in personal injuries, do hereby discharge and agree to hold harmless and safe from any and all liabilities Bella School of Dance, Inc., its officers, agents, instructors, and employees from any and all claims, demands, rights, actions, and causes of action arising out of the activities of said business on account of, or in any way arising out of, any and all known and unknown personal injuries and property damage, including consequential damages, which I am now, or may hereinafter have as the parent and/or guardian of the said minor, or which said minor may have on their own behalf.

I agree to the Release from Liability above on behalf of myself and all registered students. *

I give permission for all registered students to be photographed for keepsake and promotional advertising photographs, videos, or other media at Bella School of Dance.

Thank You!

Your registration has been received. We'll be in touch within 24 hours to confirm enrollment and next steps.

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