It is important that we have your most updated information. Please fill out the attached form and mail it to the studio or simply fill out the information below.Your information will be sent to us securely and will not be used for any other purposes but for our internal use.  Thank you!
Registration Information
Carlene Nazarian Dance Center
First Name
Last Name
Child's Nickname
Date of Birth
Address
City
State
Zip
Home Phone
Email 1
Mother's name
Mother's cell phone
Father's name
Father's cell phone
List chronic conditions, dietary restrictions, or medications:

Photo Release
I give permission to the Carlene Nazarian Dance Center to publish my child's name and photograph in the CNDC Newsletter, website, newspapers or publications.                            Please type initials if yes you agree.
Emergency Authorization
I give my daughter / son permission to participate in the dance program offered at "The Carlene Nazarian Dance Center." I will not hold "The Carlene Nazarian Dance Center" or its agents or employees liable in the event of any accident or injury. If I cannot be reached in an emergency, I give permission for the staff of "The Carlene Nazarian Dance Center" to provide first aid treatment to my child, when necessary and in the event of a more serious illness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility to receive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment as is medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that "The Carlene Nazarian Dance Center" personnel will make every effort to contact me regarding any emergency involving my child.


Typing my name is equivalent to my signature and agreement to Emergency Authorization as stated above.
Online Registration Form 2016 - 2017
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Email 2
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