2021-2022 Dreams Studio Registration
Student’s Name _____________________________________________________ Birthdate __________________________ Age_________________
Address ________________________________________________________ City _____________________ State_______________ Zip ____________
Parent’s/ Guardian’s Names ____________________________________________________ Email _________________________________________
Home Phone # _______________________________ Cell # _______________________________________ Yes ______ I receive Text Messages
Mother's/ Guardian's Place of Employment ______________________________________________ Work # ______________________________
Father's/ Guardian's Place of Employment ______________________________________________ Work # ______________________________
Emergency Contact __________________________________________________ Phone Number _________________________________________
Relationship to Student ___________________________________________________ Allergies _________________________________________
*I hereby acknowledge that: I am enrolling in a year-long performance-based class. I will attend all classes,
unless not medically able to or prior notice is given. I will treat my classmates, Mrs. Kiel and myself with respect!
**I hereby acknowledge that: Dreams Studio, LLC, Elkhorn Area School District, Lakeland Players Performing Arts Theatre,
Jennifer Kiel and all instructors disclaim liability for theft, property loss, damage or personal injury sustained on the premises
and arising out of class. My student has no medical or physical condition in which dance would be against his or her
doctor’s recommendation. I also release any photos that would be taken for the promotion of Dreams Studio.
Please check ALL that apply
Interested in Competitions? YES _____ NO ______
Class Interest: Combo _____ Lyrical _____ Hip Hop _____ Musical Theatre _____ Pre-Pointe _____ Pointe _____ Dreamettes _____
Previous Dance, Voice or Theatre experience __________________________________________________________________________________________________
Student Signature ______________________________________________________ Parent Signature ___________________________________________________
*Please include $30.00 registration and Quarterly fee to reserve your child's class.
Online payments available or mail registration and fee to
PO Box 625
Elkhorn, WI 53121