Student's Name* First Last Date of Birth*Parent's Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Home Phone*Cell Phone*Work PhoneEmergency Contact Name*Emergency Contact Phone*Interested in*Summer SessionFall SessionClasses desired to enroll in:Choose all that apply: Lyrical Ballet Hip Hop Jazz Competitive Dance Team Pointe Tap Tumbling Earliest possible class time?*Days of the week NOT available* Monday Tuesday Wednesday Thursday Friday Saturday How did you find out about us?If your child has any medical conditions that you feel his/her teacher should be aware of, please list them here:I certify that my child is in proper physical condition to take part in dance/tumbling/cheer classes. I realize that there are certain risks possible in these classes. I agree to assume the risk of all injuries or damage that may arise from my child's participation in classes at Showtyme Xtreme Athletics & Dance. In consideration of the above I hereby release and hold harmless Showtyme Xtreme Athletics & Dance, it's teachers, an downers from and against any liability or claim for any loss of property, injury, misadventure, harm, cost or damage sustained as a result of my child's participation in classes at Showtyme Xtreme Athletics & Dance.Confirm:* I have read this release and understand it's meaning. Signature of Parent or Guardian*Date
