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Registration Form
Ravel Dance Studio
703-437-9664
Date __________________
Parent or Guardian Name _________________________________________________________
Address _______________________________________________________________________
City ____________________________ State ___________ Zip code _____________________
Home Phone ___________________________________________________________________
E-mail Address _________________________________________________________________
Student’s Name _________________________________________________________________
Student’s Age _________________________________ Date of Birth _____________________
Name of Class __________________________________________________________________
Day _____________________________ Time _________________________________
Previous Dance Classes __________________________________________________________
How did you hear about Ravel Dance Studio? ________________________________________
______________________________________________________________________________
Has the student ever had a serious illness? (Y) (N)
Has the student ever sustained a serious injury? (Y) (N)
Does the student have any allergies? (Y) (N)
Does the student have asthma? (Y) (N)
Is there any pertinent information that we should
be aware of to better able us to teach the student properly? (Y) (N)
Is yes, please explain? ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signature _____________________________________________________________________
Contact person in case of emergency ________________________________________________
I agree to hold the Ravel Dance Studio, Degas Inc. and the designated representatives harmless for all liability so
long as the aforementioned are acting with industry standards and practices
Please fill out and submit along with a $100.00 deposit to:
Ravel Dance Studio
1488 North Point Village Center
Reston, VA 20194
Ravel Dance Studio
703-437-9664
Date __________________
Parent or Guardian Name _________________________________________________________
Address _______________________________________________________________________
City ____________________________ State ___________ Zip code _____________________
Home Phone ___________________________________________________________________
E-mail Address _________________________________________________________________
Student’s Name _________________________________________________________________
Student’s Age _________________________________ Date of Birth _____________________
Name of Class __________________________________________________________________
Day _____________________________ Time _________________________________
Previous Dance Classes __________________________________________________________
How did you hear about Ravel Dance Studio? ________________________________________
______________________________________________________________________________
Has the student ever had a serious illness? (Y) (N)
Has the student ever sustained a serious injury? (Y) (N)
Does the student have any allergies? (Y) (N)
Does the student have asthma? (Y) (N)
Is there any pertinent information that we should
be aware of to better able us to teach the student properly? (Y) (N)
Is yes, please explain? ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signature _____________________________________________________________________
Contact person in case of emergency ________________________________________________
I agree to hold the Ravel Dance Studio, Degas Inc. and the designated representatives harmless for all liability so
long as the aforementioned are acting with industry standards and practices
Please fill out and submit along with a $100.00 deposit to:
Ravel Dance Studio
1488 North Point Village Center
Reston, VA 20194
1488 North Point Village Center
Reston, VA 20194
703.437.9664
Reston, VA 20194
703.437.9664