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Parent/Guardian Name *

Child's First & Last Name: *

Street Address: *

City, State, Zip *

Email: *

Phone Number: *

Which class are you signing up for? (If more than one, please list all)

(Hip Hop Dance, Gymtyme (Gymnastics), Cheer, and/or Ballet)

What is the child's birthday? *

YYYY

School Name & School Address Child Attends *

I understand that this is a physical program and Jazzerettes & Gymtyme cannot be responsible for any injuries incurred. *

I agree to the above statement.

Required

Typed Signature: Type your full name to agree to the above statement.

I understand class fees are due by the 7th of each month, and after the 7th a $15 late fee will be incurred *

I understand

Required

How did you hear about us?

An email from the school

Flyer in the school lobby

Child did a free a trial

Referral from a friend

Referral from school employee

Yard Sign in Front of School

Other:

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