Party Registration Form

First name___________________ Last name______________

Address_________________ City _______________State_________ Zip Code_________

Date Of Birth____/_____/_______

Occupation( for professional use only)_______________________

Home Phone_(_____)________-________________

Mobile Number_____________________________

Email Address______________________________

Fax (______)__________-___________________

Number of Guests Attending__________________

Special Event_____________________________

In Case Of Emergency
First name ______________ Last name ________________

Home Phone_(_____)_______-_________

Relationship______________________

Mobile Number_(______)_______-____________

I_______________________________________ Acknowledge the above information is true and

correct I have read and accept the terms, conditions, class policies, fees and charges of Pole
Control Studios. I waive and release any and all claims whatsoever arising from my participation
in Pole Control Studios Parties.

We use the above information for newsletters and important messages to you. We do not
share this information with any third party

Signature________________________________ Date_______________