TU LEFT FEET SPRING 2020 6 WEEK CLASS REGISTRATION FORM
*Only 1 student per registration form.
*Total tuition due is listed next to the class below.
*Tuition is due in full at your child's 1st class.
Email address *
Please select the class / classes you would like to register for: *
Required
Student's 1st Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Email Address *
important updates, information, and receipts will be sent to this address
Your answer
Parent or Guardian's Cell Phone *
emergency contact
Your answer
Parent or Guardian's Name *
emergency contact
Your answer
Alternate Emergency Contact Information *
who do we contact if we can not reach the emergency contact listed above?
Your answer
Physical / Billing Address *
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 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 2020 dance season.
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.
Previous Experience
Your answer
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
Sibling Registered @ Tu Left Feet
(if "yes" please provide sibling's 1st + last name in the "other" box)
A copy of your responses will be emailed to the address you provided.
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