REGISTRATION More Photos Print this form out and mail or bring it into the studio.

Student Name_______________________Age_______Birthday_________Parent__________________

Address____________________City___________Zip_________Phone's_________________________

How did you find out about us?________________________circle one New Student or Returning Student

Name of Class_______________Day_______class time_________Start Date_______Tuition___________

Policies & Procedures: I the undersigned parent/guardian have read the policies and procedures and agree to them. Hold Harmless: I assume all risks and hazards incidents to participating in the activity and do hereby waive, release, absolve, indemnify and agree to hold harmless the Express Yourself Studios, supervisors, participants and instructors for any claim arising out of any injury to myself/child. (Parent or guardian signature required for all participants under 18 years of age.) I, the undersigned, parent/guardian of the participant, am fully aware of the potential dangers and risks inherent in this activity, including physical injury, death or other consequences that may arise or result directly or indirectly from participants in this activity. Promotional: I, the undersigned, parent/guardian give my permission for photos taken during class or performances and can be used for promotional purposes by Express Yourself Studios.

Signature (circle one)participant parent guardian____________________________________________Date______________

Visa & Mastercard Accepted ****Card Number____________________________Expiration date_________

Approval Code________ Name on the card__________________Signature__________________Date_____

phone 425-482-2075 email xys@mindspring.com Website by Pamela Hohner Graphic Design, Copyright © 2001 Express Yourself Studios, Mill Creek, WA. All right reserved.