TU LEFT FEET SPRING 2020 REGISTRATION FORM
Only 1 Student Per Registration Form.
Please Note Discounts On Our Tuition Information Page...SAVE $
$50 Registration Fee + 1st Month's Tuition are due upon registration.
$50 Registration Fee + 1st Month's Tuition will be automatically drafted from the card you provide on this form.
Email address *
Please select the 1st Class you would like to register for: *
Please select the 2nd Class you would like to register for:
Please select the 3rd Class you would like to register for:
Please select the 4th Class you would like to register for:
Student's 1st Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
Your answer
Student's Current Grade Level *
2019-2020 school year
E-Mail Address *
important updates, information, newsletters and closings will be sent to this address
Your answer
Parent or Guardian Cell Phone *
(Emergency Contact)
Your answer
Parent or Guardian's Name *
(Emergency Contact)
Your answer
Alternate Phone *
what number do we contact if we can not reach the emergency contact listed above?
Your answer
Secondary Parent or Guardian's Name *
who do we contact if we can not reach the emergency contact listed above?
Your answer
Previous Experience *
please select any and all that apply
Required
Length / Location / Level of Previous Experience
this will help us determine the appropriate level and class for your child
Your answer
Allergies, Previous Injuries, Illnesses, etc.
Your answer
Release of Claims and Treatment Authorization
I am aware that dance, cheer, gymnastic and any physical exercise associated with it, place unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and/or myself, I assume this risk and agree that Tu Left Feet, LLC and its staff shall not be liable in anyway for the injuries sustained during attendance at the studio, located at 2656 Anderson Highway, Powhatan, VA 23139 or any of its away functions. I grant my child/myself permission to participate in the 2019-2020 season; and I release and discharge any claims, demands, actions, judgments, and executions to which the students, heirs, executors, administrators or assigns may have, or may claim to have against Tu Left Feet, LLC, its successors, its assigns for all personal injuries caused by, or from the above activities or any activities related. Further, I grant, Tu Left Feet, LLC and its employees permission to authorize any emergency medical treatment that may be required during the 2019-2020 dance session.
Photography Release *
I, the parent/guardian (or student, if 18+) authorize Tu Left Feet, LLC and/or its representatives, agents, or staff to use any photographs of my child (or myself), for any purpose, including publicity, choreographic archives, promotional materials and/or any other reason deemed appropriate by the artistic staff or marketing director.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy