_tjdance View Instagram post by _tjdance Dec 26 Open post by _tjdance with ID 18067330319532184 _tjdance View Instagram post by _tjdance Dec 19 Open post by _tjdance with ID 17904412656161816 _tjdance View Instagram post by _tjdance Dec 12 Open post by _tjdance with ID 18003344972830270 _tjdance View Instagram post by _tjdance Dec 10 Open post by _tjdance with ID 18086268818042336 _tjdance View Instagram post by _tjdance Dec 7 Open post by _tjdance with ID 17856966039569135 _tjdance View Instagram post by _tjdance Dec 5 Open post by _tjdance with ID 18400655395127268 _tjdance View Instagram post by _tjdance Dec 3 Open post by _tjdance with ID 18092139158509539 _tjdance View Instagram post by _tjdance Dec 2 Open post by _tjdance with ID 18108354508619232 _tjdance View Instagram post by _tjdance Nov 30 Open post by _tjdance with ID 18100101640704490 _tjdance View Instagram post by _tjdance Nov 27 Open post by _tjdance with ID 18084861833491612 _tjdance View Instagram post by _tjdance Nov 20 Open post by _tjdance with ID 18081788228167001 _tjdance View Instagram post by _tjdance Nov 19 Open post by _tjdance with ID 18081635129103233 _tjdance View Instagram post by _tjdance Nov 18 Open post by _tjdance with ID 18099008818704084 _tjdance View Instagram post by _tjdance Nov 16 Open post by _tjdance with ID 18364443187094874 _tjdance View Instagram post by _tjdance Nov 12 Open post by _tjdance with ID 18097602631754480 _tjdance View Instagram post by _tjdance Nov 11 Open post by _tjdance with ID 17867079555474989 _tjdance View Instagram post by _tjdance Nov 7 Open post by _tjdance with ID 18079541738149093 _tjdance View Instagram post by _tjdance Nov 7 Open post by _tjdance with ID 18082958474078879 _tjdance View Instagram post by _tjdance Nov 6 Open post by _tjdance with ID 18087660886939852 _tjdance View Instagram post by _tjdance Nov 6 Open post by _tjdance with ID 17853421119570065 Follow on Instagram Student Information Form If you've never taken a class with TJ Dance, or you're a current student who needs to make sure we have your latest information, this is the form for you! "*" indicates required fields How many students are you registering? 1 2 3 4 5 Parent Name if Student is a Minor FIrst Last Name of Student* First Last Student Birth Date* MM slash DD slash YYYY Gender* F M Student 2Name of Student 2 First Last Student 2 Birth Date MM slash DD slash YYYY Gender, Student 2 F M Student 3Name of Student 3 First Last Student 3 Birth Date MM slash DD slash YYYY Gender, Student 3 F M Student 4Name of Student 4 First Last Student 4 Birth Date MM slash DD slash YYYY Gender, Student 4 F M Student 5Name of Student 5 First Last Student 5 Birth Date MM slash DD slash YYYY Gender, Student 5 F M Contact InfoEmail* Main Phone*Is the above a home phone or cell phone?* Home Cell Emergency Phone*Name of Emergency Contact* First Last Your preference for being contacted?* Phone Email Text No Preference Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Allergies or Concerns*June Recital Participation* Yes No Not Sure Classes I am enrolling in (Day, Time & Teacher):*Terms of Service - User AgreementTuition is due at your 1st class of the month. A $5 late fee may be added to tuition if you are more than one month past due.* I Agree Dance instruction may require instructors to touch the dancers body for proper placement.* I Agree You will be required to make a $50 costume deposit in December (due by Dec 1) or a costume will not be ordered for you or your child. If a costume is ordered, it is nonrefundable. You or your child will be required to participate in either the opening number or finale number, in addition to your class dances.* I Agree TJ Dance has my permission to use candid photos taken during classes and performances.* I Agree Medical Emergency: TJ Dance does not carry medical insurance for its students. If injury occurs it is understood that the students personal medical insurance will cover all costs. I give my permission for the Dance Teachers, Jayne Hancock and Peg Burnside, and other TJ Dance instructors to get medical attention for my child, in the event that a medical emergency should arise and I cannot be reached.* I Agree Liability Release: I hereby release the TJ Dance instructors, any guest instructors, any adults in charge, and the owners of the land and building of TJ Dance’s residency from any liability resulting in accident or injury while participating in any activity at TJ Dance. This also includes any activities in the waiting area or parking lot. TJ Dance does not supervise the waiting area or the parking lot. I certify that my level (or my child’s level) of physical condition determined by my physician or myself allows me to safely participate in classes. My signature states that I have read and understand this liability release.* I Agree
