_tjdance View Instagram post by _tjdance Oct 20 Open post by _tjdance with ID 18076439012577387 _tjdance View Instagram post by _tjdance Oct 16 Open post by _tjdance with ID 17994914241050838 _tjdance View Instagram post by _tjdance Oct 16 Open post by _tjdance with ID 17914217184501057 _tjdance View Instagram post by _tjdance Oct 12 Open post by _tjdance with ID 18067180832783339 _tjdance View Instagram post by _tjdance Oct 11 Open post by _tjdance with ID 17911984977506239 _tjdance View Instagram post by _tjdance Oct 10 Open post by _tjdance with ID 18110329922225985 _tjdance View Instagram post by _tjdance Oct 9 Open post by _tjdance with ID 18095887982137593 _tjdance View Instagram post by _tjdance Oct 7 Open post by _tjdance with ID 18143941540587544 _tjdance View Instagram post by _tjdance Oct 3 Open post by _tjdance with ID 17989918628859281 _tjdance View Instagram post by _tjdance Oct 1 Open post by _tjdance with ID 18636812074061553 _tjdance View Instagram post by _tjdance Sep 30 Open post by _tjdance with ID 18111068929870958 _tjdance View Instagram post by _tjdance Sep 29 Open post by _tjdance with ID 17954235408256501 _tjdance View Instagram post by _tjdance Sep 28 Open post by _tjdance with ID 18124961488862934 _tjdance View Instagram post by _tjdance Sep 28 Open post by _tjdance with ID 17946871944316559 _tjdance View Instagram post by _tjdance Sep 23 Open post by _tjdance with ID 18099922343566622 _tjdance View Instagram post by _tjdance Sep 23 Open post by _tjdance with ID 17873766432633624 _tjdance View Instagram post by _tjdance Sep 16 Open post by _tjdance with ID 18628608013029985 _tjdance View Instagram post by _tjdance Sep 16 Open post by _tjdance with ID 17945018436325585 _tjdance View Instagram post by _tjdance Sep 8 Open post by _tjdance with ID 18120325354901122 _tjdance View Instagram post by _tjdance Sep 4 Open post by _tjdance with ID 18141306067601975 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* Gender* F M Student 2Name of Student 2 First Last Student 2 Birth Date Gender, Student 2 F M Student 3Name of Student 3 First Last Student 3 Birth Date Gender, Student 3 F M Student 4Name of Student 4 First Last Student 4 Birth Date Gender, Student 4 F M Student 5Name of Student 5 First Last Student 5 Birth Date 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
