September 15th, 2008 - June 5th, 2009 Registration Form Dancer's Name: Parent (or legal guardian): Address: Home Phone: Work Phone: Email Address: Dancer's Age: School Grade Level: Emergency Contact Person: Contact's Phone: Relationship: Dance Class(es) Selection: Dance Shoe Order Ballet Slipper Street Shoe Size: Jazz Shoe Street Shoe Size: Tap Shoe Street Shoe Size: Waiver: I understand that dance, like any physical activity carries the risk of injury. I agree to allow the emergency contact listed on my registration form to be notified if I can not be reached in the event of any unforeseen circumstance. I will release Melissa Posthauer, Mountains in Motion Dance Project, the Holy Ghost Academy and the Saranac Lake High School of any responsibility if any injury should occur. I will take full medical responsibility if any injury should occur. I understand and agree to these policies. _________________________________________________________________ Signature of Parent or Legal Guardian                    Date To register, print, fill out and sign form, enclose check payable to Mountains in Motion Dance Project and mail to: Melissa Posthauer       30 Bloomingdale Ave.       Saranac Lake NY, 12983 Questions? E-mail or call (518 891-9085) Melissa.