Jump Into Motion Dance Academy-Registration Form
Please read all class and tuition information on our website before completing this form. By filling out and submitting this form, you are acknowledging that have read all policies and fully understand them.
Child's Name *
Your answer
Please choose one *
Date of Birth *
Month/Day/Year
Your answer
If you have any additional children in your family taking Jump Into Motion Classes, please specify their names, male or female, and age
Your answer
Does your child have any health issues that could affect their participation or that the instructor should be made aware of? *
If you checked yes, please specify.
Your answer
School or Child Care at which they are taking Jump Into Motion Class *
Class Start Date *
Month/Day/Year
Your answer
Parent or Guardian Responsible for Payment and Child(ren)'s Liability *
Your answer
Day Phone Number *
Your answer
Evening Phone Number *
Your answer
If you would like to receive text messages with tuition reminders and other updates, please specify the cell phone number you would prefer us to use.
Your answer
Email Address(es) (E-statements and class updates will be sent to this email address) *
Your answer
Re-enter Email Address(es) *
Your answer
Mailing Address *
Your answer
By checking this box and submitting this form, I hereby acknowledge that I have voluntarily applied for the services of Jump Into Motion Dance Academy. I understand that neither Jump Into Motion Dance Academy, it’s teachers, contracted workers, or volunteers are liable for any injury or damage of any kind caused during class or as a future result of instruction. I also understand that my child’s school, day care, or any class location or organization or business associated with it are responsible for any injury or damage of any kind caused during class or as a future result of instruction. I have read all information on tuition policies, course descriptions, and the entirety of this form and I fully understand all policies of Jump Into Motion Dance Academy. *
Required
I hereby give Jump Into Motion Dance Academy permission to use my child’s photograph for promotional purposes including flyers, posters, brochures, their websites, and other advertising. I understand that my child’s name will never be used. I also understand that I may not be notified when the picture is being used and I will not be financially compensated for the use of my child’s picture. *
How are you paying the first month's tuition and registration fee? Payments must be received for your child to start classes. *
PayPal payments can be made on our website. You can mail payments to 2886 S 9th St Apt B Kalamazoo, MI 49009. Payments are not to be handled by any teachers or staff at your child's school or child care.
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