Tiny Toes Dance Student Registration Form: 2018 - 2019 School Year
Parent and Student Information:
Student First and Last Name
Student Date of Birth (MM/DD/YYYY)
School Name & Class Choice
Ha'Penny Montessori - Ballet & Jazz Dance
Harrison Street Academy - Ballet & Jazz Dance
The Karter School - Ballet, Jazz, & Tap Dance 10am
Kiddie Academy Ashburn - Ballet, Jazz, & Hip Hop Dance
Kiddie Academy Moorefield Station - Ballet, Jazz, & Hip Hop Dance
Kids R Kids South Riding - Ballet, Jazz, & Tap Dance (ages 2-3)
Kids R Kids South Riding - Jazz & Hip Hop Dance
Kids R Kids South Riding - Ballet, Jazz, & Tap Dance (ages 3-5)
Kids R Kids South Riding - Afterschool, Jazz & Hip Hop Dance
Leesburg Open Arms - Ballet & Jazz Dance
LePort Montessori - Ballet & Jazz Dance
LePort Montessori - Jazz & Hip Hop Dance
Primrose School of Ashburn at Broadlands - Mini Movement
Primrose School of Ashburn at Broadlands - Perfect Plies
Primrose School of Ashburn at Broadlands - Hip Hop Hooray
Sugarland Learning Academy Leesburg - Ballet & Jazz Dance
Winwood Ashburn - Ballet & Jazz Dance
Winwood Brambleton II - Ballet & Jazz Dance
Winwood Lansdowne - Ballet & Jazz Dance
Students Classroom/Class Name
I/we realize that participation in dance class requires physical movement which could result in personal injury. Although precautions are made, injuries and accidents may happen. By completing registration for Tiny Toes Dance, LLC, I/we acknowledge and assume all risks related to class in the space used.
I/we agree to release and hold harmless Tiny Toes Dance, LLC and (school location), including teachers, dancers, staff members, and facilities used, from any cause of action, claims, or demands now and in the future. I/we will not hold Tiny Toes Dance, LLC and (school location) liable for any personal or property injury and damage that may occur before, during, or after class. In the case that any unsafe conduct or conditions arise, I/we agree to contact Tiny Toes Dance owner and school location director to report concerns as soon as possible.
I give Tiny Toes Dance, LLC permission to use photos taken in class for promotional material online and in print.
Check the box below if you read and understand the release above
Yes, I read and understand the release above
Sign your name for release acknowledgement
Date your signature
Referred by Friend (please list name below)
Thank you for enrolling in Tiny Toes Dance! Click submit then continue to payment page to finalize your registration.
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