• jpsd 2009/2010 Registration

  • $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.:________________________________

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