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jpsd 2009/2010 Registration
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$20 registration fee (individual) $30 registration fee (family) $10 rEGISTRATION FEE (cOMPANY MEMBER)
Non refundable
STUDENT’S NAME: _____________________________________________________
STUDENT’S AGE: _____________________________________________________
DATE OF BIRTH: _______________________________(please include year)
PLEASE CIRCLE YOUR CHOICES:
- pRE BALLET AND Tap
- COMBO AGES 5-7.5 (BALLET, TAP AND JAZZ)
- COMBO AGES 8-10.5 (BALLET, TAP AND HIP HOP)
- TAP
- BALLET
- Jazz
- Hip Hop
- Lyrical
- moderN/CONTEMPORARY
- Pointe
- IRISH
- ZUMBA
- CONTEMPORARY TAP FUSION
- TURNS, LEAPS AND JUMPS AND CONDITIONING FOR DANCERS
- CREW
- COMPANY
- PRIVATE
- SEMI
NAME OF PARENT/GUARDIAN: ________________________________________
MAILING ADDRESS:___________________________________________________
HOME PHONE: _____________________________________________________
CELL PHONE: _____________________________________________________
EMAIL: _____________________________________________________
MEDICAL CONDITIONS/ALLERGIES OF STUDENT:_________________________
INSURANCE CARRIER AND POLICY NO.:________________________________
DANCE EXPERIENCE: (if so, where and how many years):
The Jennifer Prete School of Dance, its instructors, and volunteers are not liable for personal injuries or loss of, or damage to personal property. Each student may decline to participate in any activity and is responsible for informing the instructor or the Director of any limitations, physical or other, which may prevent full participation in the activity.
I hereby assume the risk for any injury that I/my child may sustain while participating in the activities offered at The Jennifer Prete School of Dance. "Activities" include all in-house activities, as well as off-site activities, including, but not limited to conventions, competitions, dress rehearsals, recitals, etc. I agree to release and hold-harmless and forever discharge The Jennifer Prete School of Dance, its officials, faculty and staff, agents, other employees or volunteers from any actions, suits, damages, claims or judgments that may result from any personal injury that my child sustain while on the premises of The Jennifer Prete School of Dance and at all off-site activities offered to my child.
I HAVE READ THIS ENTIRE RELEASE AND AGREE TO IT:
Parent/Guardian________________________________________________________
Signature: ___________________________________________Date:_____________
Please send completed registration form to:
email: jennifer@jpsdri.com
address: 1 Charlestown Beach Road, Charlestown, RI 02813
fax: (401) 633-7168