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New Student Information Form
Please copy, paste and print the student information form below. Fill it out and bring it with you to class. If you do not have a printer, I have extra copies. I ask that you fill it out beforehand, if you can, so you will have more time to dance. Mahalo!



Student Information




Student’s first and last name:___________________________________________________


Parent/guardian’s first and last name, if not the student: ________________________________________________________________________


Street address _____________________________________________________________


City ________________________________Zip code _____________________________


Home phone number:_______________________ Cell phone:________________________


Email (if you have one) _______________________________________________________





Emergency contact’s name:____________________________________________________


Emergency contact’s phone number:_____________________________________________





Terms and conditions


Classes will be one (1) hour long unless otherwise stated. Parents will be responsible for picking up their children after class. Please be on time. If the parent is unreachable, I will contact the emergency contact listed above for pick-up. If the student will be unable to attend a class, please notify me (either by phone or email) ahead of time. Payment will be due for four (4) classes (unless otherwise stated) on the first Thursday of every month. Only cash or check (made out to Nalani Francisco) in the exact set amount will be accepted. We will take every precaution to avoid any injury. We are not responsible for any injuries caused by roughhousing, horseplay or neglect. A copy of this signed form can be made upon request.





I agree to the above terms:




____________________________________________________


Student’s signature




------------------------------------------------------------------------------ Date: _______________


Parent’s/guardian’s signature


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