Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother Name *

First Name

Last Name

Mother Phone *

(###)

###

####

Mother Work Phone *

(###)

###

####

Father Name *

First Name

Last Name

Father Phone *

(###)

###

####

Father Work Phone *

(###)

###

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Days Preferred *

Monday

Tuesday

Wednesday

Thursday

Earliest Time of Day Available *

Hour

Minute

Second

AM PM

Select Desired Classes *

Ages 18mo-3yr First Steps

Ages 3-4 Jazz/Acro

Ages 3-4 Tap/Ballet

Ages 5-6 Ballet

Ages 5-6 Jazz

Ages 5-6 Tap

Ages 5-6 Acro

Ages 5-6 Hip Hop

Ages 7-9 Ballet

Ages 7-9 Jazz

Ages 7-9 Tap

Ages 7-9 Acro

Ages 7-9 Hip Hop

Ages 10-12 Ballet

Ages 10-12 Jazz

Ages 10-12 Tap

Ages 10-12 Acro

Ages 10-12 Hip Hop

Ages 13+ Ballet

Ages 13+ Jazz

Ages 13+ Tap

Ages 13+ Acro

Ages 13+ Hip Hop

Competition Team Ballet

Competition Team Jazz

Competition Team Tap

Competition Team Acro

Competition Team Hip Hop

Competition Team Lyrical

Competition Team Pointe

Competition Team Jump/Turn

Competition Team Stretch

Additional Class- Private

Additional Class- Duet/Trio

Additional Class- Baton

Registration Release *

I understand and recognize the risk of physical injury inherent in dance and dance performance and I am willing to assume those risks. I agree that I will not hold TURN IT OUT Dance Academy, or its owners, directors or employees liable for injuries sustained or illnesses contracted by me or my children or students while in attendance and or participating in any activity at TURN IT OUT Dance Academy, or traveling to and from off premises for rehearsals and performances.

I Accept