Please print this page, complete the
form below, and mail it, along with your payment, to the address at the bottom of the page. We look
forward to seeing you.
- Thank you!
New Student
2nd year Student
Name
Address
City
Zip
Parents
School
Phone
Grade
Email
I hereby authorize Nordquist Dance Studio to
obtain emergency medical treatment for my child.
I hereby indemnify, hold free and harmless,
Nordquist Dance Studio from any and all liability.
Parent ________________________________________
Date ____________________ Signature
Mail To:
Nordquist Dance Studio
194 Brush Creek Rd.
Santa Rosa, CA 95404
PH: 707-538-7618