In-Studio Class Sessions

Dancer Name *

First Name

Last Name

Dancer Name 2

First Name

Last Name

Birthday *

MM

DD

YYYY

Birthday 2

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

(###)

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Classes *

Ages 7-9 Petite Ballet | Wednesday 5:00-6:00pm

Ages 7-9 Petite Acro | Wednesday 6:00-7:00pm

Ages 7-9 Petite Tap | Saturday 12:30pm-1:30pm

Ages 7-9 Petite Petite Jazz | Saturday 1:30pm-2:30pm

Tuition Agreement *

Hi Dance Moms Just wanted to take a moment of your time to briefly go over our payment process. All Payments are due on the 1st of every month. There is a one week grace period so all payments turned in on or before the 7th of each month will NOT be considered late! All payments turned in after the 7th but before the 15th will incur a minimal late fee of $10.00 All payments received after the 15th will incur a $15.00 late fee.

I Agree

Medical Agreement *

I am aware that participation in dancing is potentially dangerous and involves risk of injury. I understand that these risks include, but are not limited to injury to ligaments,muscles, tendons, bones, and other aspects of the body that may include head, neck, or spine. Due to the dangers of this activity, I understand the importance of my child’s following the teacher’s instructions regarding techniques, training, and other rules and agree that my child will obey these instructions. In consideration for allowing my child top participate Dance for Joi Dance Company activities , I hereby assume all the risks associated with the sport of dance, and I agree to release Dance for Joi Dance Company and its employees or agents from any and all liability/responsibility which may arise in connection with my child’s participation in activities at Dance for Joi Dance Company

I Agree

Media Agreement *

By agreeing this form, I understand that I am giving unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Dance for Joi Dance Company for a variety of purposes and that these images may be used without further notifying me. I do understand that the child’s last name will not be used in conjunction with any video or digital images.

I Agree