REGISTRATION FEE – $20 INDIVIDUAL   $35 FAMILY

To register, please complete the following form and mail (or bring) check to:
Studio 82, 13499 W.130th, N. Royalton, OH, 44133

Your registration is not complete until we receive your check.

    Your Name (required)

    Your Email (required)

    Child's Name (required)

    Address (required):
    City: Zipcode:

    Child's Birthdate (required): Current Age:

    Mom's Name (required): Mom's Phone:

    Dad's Name (required): Dad's Phone:

    Home Phone:

    Phone number you prefer us to call (required):

    Student Cell Phone:

    In which classes are you interested (please select at least one):


    Studio 82 Request for Registration & Release From Liability

    We, the undersigned, parent or guardian of the child named here, do hereby request that they be permitted to register and participate in STUDIO 82’s dance program and recital. Recognizing the possibility of physical injury, we hereby release, discharge, and/or otherwise indemnify STUDIO 82, its employees, directors, teachers and other associated personnel, including the owners of the facilities against any claim by or on behalf of the youth named below, as a result of the registrant’s participation in STUDIO 82’s dance program. We do assume all risks and hazards incidental to the conduct of the scheduled activities, and the transportation to and from the activities.

    Purpose: To enable parents and guardians to authorize the provision of emergency
    treatment for children who become ill or injured while under school authority, when
    parent or guardians cannot be reached.

    To Grant Consent:

    I hereby give consent for the following medical care providers and local hospital to be
    called:

    Doctor (required): Doctor's Phone:

    Medical Specialist: Phone:

    Preferred Hospital (required):

    Medical History:

    In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above named doctor, or in the event the designated practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

    By submitting this form, you accept and agree to the Studio 82's request for registration and release from liability.