Hall Rental/Dance Lessons | Ballroom Dancing | Covina & San Gabriel Valley, CA

				REGISTRATION FORM		Print Form

PLEASE REMEMBER:
Fill out registration form completely. Be sure to sign and date the bottom of the form.
Make check payable to WHERELSE DANCE STUDIO, mail form 1 week before the class starts.
Mail or your registration form and payment to 1034 N Citrus Ave., Covina CA 91722.
There is a $25 returned check fee for every check returned for non-payment.
For information, please call us at 866-764-0325.
To pay online go the bottom page.
First Name		M	Last Name			Home Phone
						( )
Home Address			City	Zip Code		Alternate Phone
						( )
				Email Address:

Class Name		Date		Start Time				Fee
1							$
2							$
3							$
					Total Class Fees

I hereby absolve WHERELSE DANCE STUDIO, its employees, and officers from all
liability which may arise as the result of my participation in the above activities; and in the event that the
above named participant is a minor, I hereby give my permission for his or her participation as indicated
above and in so doing absolve the WHERELSE DANCE STUDIO, its employees and
officers from such liability. I am aware that if my child or I may have registereDDdd for a class involving
physical activity, I have taken care to enroll at a class level appropriate to my or my child's phycial
abilities and/or medical condition.

I ACKNOWLEDGED THAT I HAVE READ THE FOREGOING AND HAVE BEEN FULLY AND COM-
PLETELY ADVISED OF THE INCIDENTAL TO PARTICIPATE IN THE CLASS ACTIVITY.
Signature	_________________________			Date _____________
REFUND POLICY
Notification of withdrawal must be given to Wherelse Dance Studio management 3 days prior to the second
scheduled class meeting. In the event that a class is cancelled by Wherelse Dance Studio, a full refund will
be issued.
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