Student's Name:_______________________________

Parent's Name:________________________________

Mailing Address:_______________________________

_____________________________Zip_______________

Email Address:_________________________________

Phone Number:________________________________

Grade:________________________________________

Male or Female:________________________________

Photo Permission: Your permission is needed for taking general pictures of your child dancing (name stated above) for digital, print, tv or website material. Pictures and video footage are taken of students with no personal information ever displayed, and we prefer to use indirect head shots. The DVD Memory Package is the main reason for this permission, since it allows students to have professional footage of themselves dancing for the first time. We thank you very much for your cooperation.

_____________________________________ Parent Signature

School Name:________________________________________

Check Included: _____ (Inquire with your school regarding fee

or click "Classes" on the menu bar.)