Amt.Paid________                                                                                             ______________

Check#_______                                                                      ___________

Cash_________             TDC Tammy's Dance Co.                 ______________________

Northside Studio 1                   Tammy Tetting                         SouthsideStudio 2

921 Shadow Dr. #4                 (863) 858-1711                        5285 S.FL. Ave.

Lakeland. Fl. 33809                                                                 Lakeland, Fl.33813

Parents_________________________________   Phone(C)____________

Email_______________________________________      (H)____________

Student_______________________________ DOB__________Age______

Student________________________________DOB_________ Age______

Student________________________________DOB_________ Age______

Mailing Address____________________________________________________________

_________________________________________________________

 City______________    State_______      Zip Code____________

Class__________________ Day_______Time______  Student________________________ 

Class__________________ Day_______ Time____Student___________________

Class___________________Day_______Time______ Student_________________________

 I release Tammy's Dance Co. from any responsibility reguarding LOST or STOLEN articles, or from any injuries that may occur at or away from the facilities to myself or my child/ren. I also understand that I must pay for my child/ren's cosfumes and recital fee by December 1Oth to meet deadlines.

ALL PAYMENTS ARE NON.REFUNDABLE.

List any additional class on the reverse side of this form.

_______________________________________                                         __________________

Parent or Guardian                                                           Date