Test 2 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.Is this registration for the 2nd or later sibling registered in the same family? No 2nd sibling 3rd or later sibling Name of first registered child HIP HOP - (Sept. to May)HIP HOP - (Sept. to May) Jr/Int Hip Hop - (ages 8-11) - Monday 5:30pm-6:15pm 47.00/mth Teen Hip Hop Friday 5:30pm - 6:15pm 47.00/mth JAZZ (Sept. to May)JAZZ (Sept. to May) Jr/Int Jazz (ages 8-11) - Monday 6:15 - 7:00pm 47.00/mth Teen Jazz (ages 12+) - Friday 6:15 - 7:00pm 47.00/mth BALLET - (Sept. to May)BALLET - (Sept. to May) Junior Ballet (age 8-12) - Friday 4:00pm - 4:45pm 47.00/mth TAP - (Sept. to May)TAP / MUSICAL THEATRE - (Sept. to May) Jr/Int Tap/Musical Theatre (ages 8-10) - Monday 7:00pm-7:45pm 47.00/mth Teen Musical Theatre (ages 12+) - Friday 7:00pm-7:45pm 47.00/mth 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 4:00pm-4:45pm 47.00/mth 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.Administrative Fee Price: Subtotal $ 0.00 CAD Tax $ 0.00 CAD 2nd sibling Discount $ 0.00 CAD 3rd or later sibling Discount $ 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