2009-2010 Registration Form
How did you hear of SCDC? (please check one):
Website    Facebook   Yellow Pages  Newspaper   School Flyer
Other 
Personal Information
Student’s Name
Address
City   State    Zip 
This is my  year with SCDC (Salem County Dance and Cheer)
Birth Date   Age    Grade 
School attending
Street shoe size   Tee shirt size 
Parent's Name
E-mail
Home phone   Cell phone 
Emergency Contact   Phone 
Please list any current allergies and/or medications:
 
 
Class Selection    
Class #1 Day Time
Class #2 Day Time
Class #3 Day Time
Class #4 Day Time
Class #5 Day Time

Registration Fees
Registration Fee is due with this form and is NON-REFUNDABLE and NON-TRANSFERABLE.
Waiver and Release
I, the undersigned parent/guardian, grant permission for my child
to participate in the activities of the Salem County Dance and Cheer studio. I hereby
acknowledge that by attending and participating in dance, gymnastics, and /or cheerleading
classes and events that there is a possibility of physical illness or serious/fatal injury to my child
and I do hereby for myself and all others who might have a similar claim waive, release and
forever discharge any and all rights and claims for injury, which may arise now or in the future
against Salem County Dance and Cheer, its owners, operators, officers, agents, or representatives,
the host School/Institution, and their representatives, for any and all damages which my child
may sustain or suffer while attending and participating in the events.

Electronic Signature         Date 
I agree to the terms
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