Test 3 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 PARENT N’ TOT TUMBLINGPARENT N’ TOT TUMBLING (Ages 18mths to 4 yrs) Saturdays 9:15am - 9:45am Sept to Dec Jan to May TINY DANCERSTINY DANCERS - (Ages 2.5 to 4) Saturdays 10:15am - 10:45pm Wait List: Sept to Dec Jan to May TINY TUMBLERSTINY TUMBLERS - (Ages 2.5 to 4) - Saturdays 9:50am-10:20am Wait List: Sep to Dec Jan to May Tiny TappersTiny Tappers - (Ages 2.5 to 4) - Saturdays 11:30am-12:00pm Cancelled: Sept to Dec Jan to May Tot Hop (intro to hip hop)Tot Hop (intro to hip hop) - (Ages 2.5 to 4) - Saturdays 11:00am-11:30pm Sept to Dec Jan to May CHILDREN'S BALLETCHILDREN'S BALLET - (Ages 5 to 7) - 37.00/mth (Sept. - May) 30 min. class Friday 4:00pm-4:30pm TAP KIDSTAP KIDS - (Ages 5 to 7) - 37.00/mth (Sept. - May) 30 min. class Fridays 6:15pm to 6:45pm TREMENDOUS TUMBLERSTREMENDOUS TUMBLERS - (Ages 5 to 7) - 37.00/mth (Sept. - May) 30 min. class Fridays 5:10pm-5:40pm MINI MOVERS (Jazz)MINI MOVERS (Jazz) - (Ages 5 to 7) - 37.00/mth (Sept. - May) 30 min. class Fridays 4:35 to 5:05pm HIP HOP KIDZHIP HOP KIDZ - (Ages 5 to 7) - 37.00/mth (Sept. - May) 30 min. class Fridays 5:45pm-6:15pm PaymentPayment Option Full Payment Monthly Payment 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 2nd sibling Discount $ 0.00 CAD Costume Deposit Price: $ 0.00 CAD Tax $ 0.00 CAD Tax Price: $ 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