Jeté Dance Studio, Inc.

Registration Form

Students Name *

Your answer

Date of Birth *

YYYY

Grade level

Your answer

Address *

Your answer

Contact Number *

Your answer

Email *

Your answer

Parent/ Guardian Name *

Your answer

Parent/ Guardian Number *

Your answer

Emergency Contact Name and Number *

Your answer

Please List any medical conditions or allergies

Your answer

Class Registering For *

Your answer

Class Day *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Time of Class *

Time

Registration Fee and Tuition *

I understand that registration fee and tuition are due to Jete Dance Studio, Inc. at the time of registration. Payment must be submited by cash, check, or credit card at Jete Dance Studio office or over the phone.

Required

Liability Waiver *

I understand and agree that with any dance, movement, or exercise class at Jete Dance Studio, Inc. there is the risk of injury. I give constent for my child or myslef (if over 18) to participate in the classes and or activites here at Jete Dance Studio, Inc. I take all responsiblity and release Jete Dance studio, Inc., the owner, employees, and instructors from all liablity if any injury or accident shall occur during all classes and activites.

Required

Medical Emergency Release *

I give Jete Dance Studio, Inc., the owner, and the opperators the permission to seek medical treatment in the event of a medical emergency for the participant if the parent or emergency contact can not be reached. I hereby agree that the participate is in good physical/mental health for the class or activity they are registered for. I have listed any and all medical conditions and allergies.

Required

Photography Waiver *

I allow Jete Dance Studio, Inc. to use all photos and videos of the participate for the sole purpose of promoting and advertising. I give my constent and agree that the participate and parent will not receive any compensation for such that is used for Jete Dance Studio, Inc.

Required

Signature *

I agree everything in this registration is accurate and up to date.

Required

Please sign and date *

Your answer

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