Test 4 - JJ DANCE Performing Arts Studio

Participant Name*
Birth Date*
MM slash DD slash YYYY
Age*
Medical Information
Medical Conditions
Contact Information
Email*
Phone number*
Emergency Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Classes
Check the boxes beside the classes you wish the above person to be registered for. Your total due will be calculated below.
Adult Dance Fit
Adult dance Fit (6 week session) - $100.00 (45 min classes)
- Adult Dance Fit - Monday 7:45pm -8:30pm
Payment
Subtotal
$ 0.00 CAD
Tax
$ 0.00 CAD
Total
$ 0.00 CAD
Release & Liability
I 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 Card
Card Details
Cardholder Name
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 notice

Medical Information