Test 1 Child's Name* Birth Date* MM slash DD slash YYYY Age*School Medical InformationMedical ConditionsContact InformationParent(s) or legal guardian* Email* Phone*Emergency Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ClassesCheck the boxes beside the classes you wish the above child to be registered for. Your total due will be calculated below.Would you like to sign up for our unlimited classes package?We offer large discount if you sign up for 6 or more classes Yes No Is this registration for the 2nd sibling registered in the same family? Yes No Name of first registered child Unlimited Classes Package* 6 classes ($225 / month) 7 classes ($250 / month) 8 or more classes ($275 / month) Unlimited Classes Package* 6 classes ($165 / month) 7 classes ($185 / month) 8 or more classes ($200 / month) Please choose 6 classes from the list belowPlease choose 7 classes from the list belowPlease choose 8 or more classes from the list belowCompetitive ClassesJAZZ (Sept. to May)JAZZ (Sept. to May) Petite Jazz Company (ages 8-10) - Tuesday 5:30pm-6:15pm 47.00/mth Junior/Int. Jazz Company - Wednesday 7:00pm-7:45pm 47.00/mth Int./Sr. Jazz Company (ages 14-17) - Thursday 4:00 - 4:45pm 47.00/mth Int./Sr.Jumps & Turns - Wednesday 4:00pm - 4:45pm 47.00/mth Petite/Jr.Jumps & Turns - Wednesday 6:15pm -7:00pm 47.00/mth JAZZ (Sept. to May) Petite Jazz Company (ages 8-10) - Tuesday 5:30pm-6:15pm Junior/Int. Jazz Company - Wednesday 7:00pm-7:45pm Int./Sr. Jazz Company (ages 14-17) - Thursday 4:00 - 4:45pm Int./Sr.Jumps & Turns - Wednesday 4:00pm - 4:45pm Petite/Jr.Jumps & Turns - Wednesday 6:15pm -7:00pm HIP HOP - (Sept. to May)HIP HOP - (Sept. to May) Petite Hip Hop Company- Tuesday 4:45pm-5:30pm 47.00/mth Int./Sr. Hip Hop Company - Thursday 4:45pm-5:30pm 47.00/mth HIP HOP - (Sept. to May) Petite Hip Hop Company - Tuesday 4:45pm-5:30pm Int./Sr. Hip Hop Company - Thursday 4:45pm-5:30pm ACRODANCEACRODANCE - (Sept. to May) Petite Acro Company (ages 8-10) - Tuesday 4:00pm-4:45pm 47.00/mth Int./Sr. Acro Company (age 11 - 17) - Thursday 5:30 - 6:15pm 47.00/mth ACRODANCE - (Sept. to May) Petite Acro Company (ages 8-10) - Tuesday 4:00pm-4:45pm Int./Sr. Acro Company (age 11 - 17) - Thursday 5:30 - 6:15pm BALLET - (Sept. to May)BALLET - (Sept. to May) Petite Ballet Company (age 8-10) - Wednesday 4:45pm - 5:30pm 47.00/mth Int./Sr. Ballet Company (age 11 - 17) - Wednesday 6:15pm - 7:00pm 47.00/mth BALLET - (Sept. to May) Petite Ballet Company (age 8-10) - Wednesday 4:45pm - 5:30pm Int./Sr. Ballet Company (age 11 - 17) - Wednesday 6:15pm - 7:00pm POINTE - (Sept. to May)POINTE - (Sept. to May) Int/Sr Pointe Company - Wednesday 7:00pm - 7:45pm 47.00/mth POINTE - (Sept. to May) Int/Sr Pointe Company - Wednesday 7:00pm - 7:45pm TAP - (Sept. to May)TAP - (Sept. to May) Petite Tap Company - Tuesday 6:15pm-7:00pm 47.00/mth Jr. Tap Company - Thursday 6:15pm-7:00pm 47.00/mth Int./Sr. Tap Company (ages 11 and up) - Thursday 7:00pm-7:45pm 47.00/mth TAP - (Sept. to May) Petite Tap Company - Tuesday 6:15pm-7:00pm Jr. Tap Company (ages 8-10) - Thursday 6:15pm-7:00pm Int./Sr. Tap Company (ages 11 and up) - Thursday 7:00pm-7:45pm LYRICAL - (Sept. to May)LYRICAL - (Sept. to May) Int./Sr. Lyrical Company (ages 14 and up) - Thursday 7:45pm-8:30pm 47.00/mth LYRICAL - (Sept. to May) Int./Sr. Lyrical Company (ages 14 and up) - Thursday 7:45pm-8:30pm CONTEMPORARY - (Sept. to May)CONTEMPORARY - (Sept. to May) Int./Sr. Contemporary Company (ages 14 and up) - Wednesday 7:45pm-8:30pm 47.00/mth CONTEMPORARY - (Sept. to May) Int./Sr. Contemporary Company (ages 14 and up) - Wednesday 7:45pm-8:30pm Would you also like to register for any recreational classes? Yes No Recreational ClassesHIP HOP - (Sept. to May)HIP HOP - (Sept. to May) Junior Hip Hop - Level 1 (ages 8-10) - Monday 5:30pm-6:15pm 47.00/mth Junior Hip Hop - Level 2 (ages 8-10) - Monday 5:30pm-6:15pm 47.00/mth Int./Teen Hip Hop Tuesday 4:45pm - 5:30pm 47.00/mth HIP HOP - (Sept. to May) Junior Hip Hop - Level 1 (ages 8-10) - Monday 5:30pm-6:15pm Junior Hip Hop - Level 2 (ages 8-10) - Monday 5:30pm-6:15pm Int./Teen Hip Hop Tuesday 4:45pm - 5:30pm JAZZ - (Sept. to May)JAZZ - (Sept. to May) Junior Jazz (ages 8-10) - Monday 6:15 - 7:00pm 47.00/mth Int/Teen Jazz (ages 11-17) - Tuesday 4:00 - 4:45pm 47.00/mth JAZZ - (Sept. to May) Junior Jazz (ages 8-10) - Monday 6:15 - 7:00pm Int/Teen Jazz (ages 11-17) - Tuesday 4:00 - 4:45pm BALLET - (Sept. to May)BALLET - (Sept. to May) Junior Ballet (age 8-10) - Monday 7:00pm - 7:45pm 47.00/mth Int./Teen Ballet (age 11-17) - Tuesday 5:30 - 6:15pm 47.00/mth Petite Ballet Tech (age 8-10) - Wednesday 4:00pm - 4:45pm 47.00/mth Int./Teen Ballet Tech (age 11-17) - Wednesday 5:30 - 6:15pm 47.00/mth BALLET - (Sept. to May) Junior Ballet (age 8-10) - Monday 7:00pm - 7:45pm Int./Teen Ballet (age 11-17) - Tuesday 5:30 - 6:15pm Petite Ballet Tech (age 8-10) - Wednesday 4:00pm - 4:45pm Int./Teen Ballet Tech (age 11-17) - Wednesday 5:30 - 6:15pm TAP - (Sept. to May)Musical Theatre - (Sept. to May) Junior Tap/Musical Theatre (ages 8-10) - Monday 4:00pm-4:45pm 47.00/mth Int/Teen Tap/Musical Theatre (ages 11-17) - Tuesday 6:15pm-7:00pm 47.00/mth Musical Theatre- (Sept. to May) Junior Tap/Musical Theatre (ages 8-10) - Monday 4:00pm-4:45pm Int/Teen Tap/Musical Theatre (ages 11-17) - Tuesday 6:15pm-7:00pm ACRODANCE - (Sept. to May)ACRODANCE - (Sept. to May) Acrodance Level 1-2: Monday 4:45pm-5:30pm 47.00/mth Acrodance Level 3-4: Monday 4:45pm-5:30pm 47.00/mth Petite Flexibility/Tumbling — Wednesday 5:30 - 6:15pm 47.00/mth Int/Sr. Flexibility/Tumbling — Wednesday 4:45 - 5:30pm 47.00/mth ACRODANCE - (Sept. to May) Acrodance Level 1-2: Monday 4:45pm-5:30pm Acrodance Level 3-4: Monday 4:45pm-5:30pm Petite Flexibility/Tumbling — Wednesday 5:30 - 6:15pm Int/Sr. Flexibility/Tumbling — Wednesday 4:45 - 5:30pm LYRICAL - (Sept. to May)LYRICAL - (Sept. to May) Lyrical (ages 8+) - Tuesday 7:00pm-7:45pm 47.00/mth LYRICAL - (Sept. to May) Lyrical (ages 8+) - Tuesday 7:00pm-7:45pm COSTUME DEPOSIT Price: PaymentPayment Option* Full Payment Monthly Payments Payment Method* Credit Card E-Transfer Cheque If you would like to set up optional payment arrangements, contact the studio. Fees non-refundable. Exceptions are made with a Doctors note stating medical reason or student is 4 years or younger. No refunds after March 1st. In the Event of a Pandemic, classes will go Online until further noticeIf you are paying by cheque, payment must be delivered to the studio before we can add the child to the class.Subtotal $ 0.00 CAD Costume Deposit Price: $ 0.00 CAD Tax $ 0.00 CAD Total $ 0.00 CAD Monthly Payment Price: $ 0.00 CAD Release & LiabilityI hereby agree to not hold Jennifer Johns Main and staff responsible for any damages or liability due to theft, accident, or injury during or resulting from my child’s participation in any capacity of or relating to any function or activity of the said JJ Dance Performing Arts Studio. I/We give JJ Dance Performing Arts Studio permission to use any pictures video taken of me, or my child for advertising purposes.* I agree to the above terms Credit CardCard Details Cardholder Name