SUMMERREGISTER

* Indicates required field

Student Name *

First

Last

Date of Birth *

Age *

Years Experience *

Prior Stuido(s) *

Daytime Classes

Evening Classes

Mother's Name *

First

Last

Primary Email *

Primary Phone Number *

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Please specify any special conditions or allergies. *

Father's Name *

First

Last

Secondary Email *

Secondary Phone Number *

Secondary Address *

Line 1

Line 2

City

State

Zip Code

Country

Medical Consent *

I Agree

Media Release *

I Agree

I approve of my child’s participation in Vibe Performing Arts programs, and certify that he/she is in good health and able to participate in the program. If medical attention is required for illness or injury, I grant permission for such care to be rendered.

I authorize images and videos to be posted on websites and social media that may be taken during events coordinated through Vibe Performing Arts.

Number of Classes *

Tuition (Due July 15) *

Daytime Classes

Evening Classes

Please Print this page for your records before submitting