Since we need a Signature on our Registrations, please choose the Printout Registration Form and fax or mail your Registration to us.
Mahalo
Student
Name _______________________________ Age ________ Birth date _________________________
Address ___________________________________ Home Ph. _______________________________
City/State ____________________ Zip _____________ School _______________ Grade _________
Father's Name _________________________ Mother's Name _______________________________
Address ______________________________ Address _____________________________________
City/State/Zip _________________________ City/State/Zip _________________________________
Phone(h) ___________ (w) ______________ Phone(h) ________________ (w) _________________
Employer _____________________________ Employer ____________________________________
Adult Responsible for Payment ________________________________________________________
Address, If Different from Above _______________________________________________________
Any Heath Problems? _______________________________________________________________
In case of emergency, please notify ____________________________________________________
Preferred Classes __________________________________________________________________
I have read West Hawaii Dance Academy tuition and school policies.
I am responsible for the full tuition for the class(es) for which I am registering and
understand that tuition is non-refundable and payable in advance.
I am aware, as with any physical activity, that dance can be a risk ?or personal injury.
I expressly assume such risk and waive any and all claims or causes of action against
West Hawaii Dance Academy, Theatre, Dance Centre, its Instructors and Contractors,
owners of B & K Commercial Park, and Yumi Hancock arising out of or connected with my
or my child s participation in classes and activities, including, but not limited to,
claims from injuries.
Signature of Parent or Guardian ___________________ Date ______ Witness _________________
The signing of this form constitutes your contract for the full amount of fees.
All fees are due prior to taking the first class. Missed classes must be made up within
two weeks of absence.
Registration Fee $15 ______ Paid(Date) ____________ Tuition paid _________________________
74-5626 Alapa Street Bay 15 Kailua-Kona, HI 96740 Ph.
(808) 329-8876 FAX (808) 329-1033 Contact us...
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