SABA Student Registration Form

Name: ________________________________________________

Home Phone: ____________________     Work or Cell Phone: _____________________

Address: _______________________________________________

City: ___________________________     Zip: _________________

E-mail: ________________________________________________

Session or workshop in which to be enrolled:

______________________________________________________

Any injuries or physical limitations? ___________________________________________

______________________________________________________________________

Extent of any previous dance training: _________________________________________

______________________________________________________________________

How did you hear about SABA?
_____ Friend/relative
_____ Phone book
_____ UW-Platteville
_____ Public appearance at ________________________________________________
_____ Newspaper ad in ___________________________________________________
_____ Other ____________________________________________________________

Waiver:

The undersigned has read and understands the policies of the Academy. S/He is aware of and accepts the risks inherent in the training of ballet/dance. S/He hereby agrees to hold Summer Hamille, Southwest Academy of Ballet Arts, Inc., the UW Board of Regents, UW-Platteville and its assigns harmless from any and all liability, loss, damage, costs or expenses that arise from the student's participation in this activity. It is also understood that occasional physical touching is necessary to assist the student in grasping the concepts of this training.

Adult Student Signature: __________________________     Date: __________________

Mail registration form to:

SABA
706 Ridge St., Suite 27
Mineral Point, WI 53565-1445