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Miss Julie’s Dance Registration Form

Student's Name
Date of Birth
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Emergency Phone
Emergency Contact
Mother's Full Name
Father's Full Name
List any other family members enrolled in our programs
List any previous experience (Dance, Gymnastics, Drama, etc.)
List any allergies, handicaps, physical conditions
List any behavioral/emotional difficulties
Please state what you expect of our program for your child
Please state your child's expectations of class
Comments
Waiver WAIVER: I, the undersigned, understand that it is required that all students be covered by his/her own family medical insurance policy. In the event injury occurs, the student's own policy will be the source of reimbursement. I intend to be legally bound for myself, my heirs and executors, my children (adopted or otherwise). I waive and release any rights and claims for damages, injuries, or disabilities against Miss Julie's Happy Feet of the Slate Belt, Inc. and it's subsidiaries, their promoters, associates, and representatives that might be incurred before, during, or after instruction or other sponsored events by the above listed. Please complete and sign registration form.
Guardian's Signature

Miss Julie’s offers dance, gymnastics, personal training
and fitness classes for children and adults.

~moving bodies and minds since 1993~

Questions or Comments?