testreg

Student Name *

First

Last

Returning Vibe Student *

Yes No

Note: There is no need to select the "None" option, that option is there to simply undo a mistaken selection

Age *

Date of Birth *

Years Experience *

Previous Studios *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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

Alternate Email

Alternate Phone Number

- -

Alternate 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 will not hold Vibe Performing Arts responsible for injuries sustained during normal class activites. I also confirm the student has health insurance coverage.

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

Number of Classes per week

Monthly Class Tuition

"The Pulse" Fee***

Total Monthly Tuition**

Registration Fee*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Please Print this page for your records before submitting