Registration Form

www.justdancz.com

908-852-1990

 

Student’s Last Name:___________________________________First________________________

Student’s Last Name:___________________________________First________________________

Student’s Last Name:___________________________________First________________________

 

Father’s Name: ___________________________Mother’s Name____________________________

 Email address:   

Address: ___________________________________City _____________________Zip__________

 

Home Telephone: ___________________________________Cell:___________________________

 

Date of Birth: _____/_____/___________         Grade in September __________________________

 

Email Address:_________________________@_____________________________

 

                Child                                                                       Class                                       Day & Time

 

(1)______________________________________________________________________________

 

(2)______________________________________________________________________________

 

(3)______________________________________________________________________________

 

(4)______________________________________________________________________________

 

Any physical issues which may interfere with dance training:________________

If so, please explain__________________________________________________________________________________________________________________________________________________________________________________________________________________

 

I agree to pay tuition in advance on the first of every month

Sign:___________________________________Date:____________________________

 

Waiver: (If student is under 18, parent must consent and sign)

I understand that dancing is a physical activity.  I have described herein any physical issues that may interfere with dance training.  I will not hold Just Dancz responsible for any injuries caused by this training if not caused by the apparent gross negligence of the teaching procedures.  I have been explained and understand the implications of signing this waiver and do so freely.

Sign:________________________________Dated:________________________

(Office use only)

Tuition:   $_______________________________Reg Fee $20.00 _____________

 

Day of Class________________________Time of Class__________________________

Dance for fitness...Dance for Life...Just Dancz