Fall Session Registration Form 2020-21
6 Week Session
Email address *
Additional email addresses in which you would like to receive important information
(use commas to separate email addresses)
Gender *
Required
Birth Date *
MM
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DD
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Age by first day of session *
Student Last Name *
Student First Name *
List any allergies and/or medical conditions you feel ATJ should be aware of
Street address *
Town *
Zip *
Parent 1 Name *
Parent 1 Phone *
Parent 2 Name
Parent 2 Phone
Emergency Contact Name
(other than above info)
Emergency Contact Number
(other than above info)
Emergency Contact Relation
New Student? *
Required
How did you hear about All That Jazz Dance Studio?
New students only. Did someone refer you All That Jazz? If so, who?
Other studio(s) or gyms attended
Any Prior Dance, Gymnastics/Tumbling, or Cheer Experience?
How many years of each style? What styles of dance?
Can All That Jazz Dance Studio use photos of student for advertisement purposes and social media? *
Required
Choose a class *
Required
Choose Session(s) *
6 Week Session $65 - Drop in Rate $15
Required
A credit will not be issued for any missed classes. No refunds once a session begins. There will be a $25 fee for any returned checks. *
Required
I agree to read and abide by the All That Jazz student handbook *
Required
WAIVER OF LIABILITY *
This agreement releases All That Jazz Dance Studio, LLC from all liability related to injuries that may occur on premises or during a performance. I agree to hold All That Jazz free from all liability including financial injuries incurred regardless of whether said injuries are caused by negligence. I also acknowledge the risks involved in dancing, cheer and gymnastics. I am participating voluntarily and all risks have been made clear to me. I agree that there are no pre-existing conditions that will increase my likelihood of experiencing injuries while engaging in these activities. I have read the terms above and understand them. I further understand that agreeing to this release, I voluntarily surrender certain legal rights.
Required
COVID-19 ACKNOWLEDGEMENT and DISCLOSURE WAIVER *
Please, complete waiver prior to first class. Failure to complete and agree to waiver will result in denied entry.
Required
*
Required
By typing my name below, I agree to each statement above and release All That Jazz Dance Studio from any and all liability for unintentional exposure or harm due to COVID-19
Today's Date
MM
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DD
/
YYYY
Payments can be made by cash, check or credit/debit card. *
Registration is not complete and spot is not held until registration form and payment are submitted. See website for prices.
Required
Credit Card Number
(no spaces)
Exp Date
CVV Code
Your chosen class may be full or student may be placed in another level/class. Once your registration form and payment is submitted, your form will be reviewed for approval and you will receive a confirmation email or phone call letting you know this class is reserved or another class is recommended. Schedule is subject to change. *
Required
Message
A copy of your responses will be emailed to the address you provided.
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