Registration & Release Form | Showtyme Xtreme Athletics & Dance

Student's Name(Required)

First Last

Date of Birth(Required)

Parent's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Home Phone(Required)

Cell Phone(Required)

Work Phone

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Interested in(Required)

We will contact you with class info closer to start of the session.

Fall Session 2023 (starts September 5th)

Classes desired to enroll in:

Choose all that apply:

Earliest possible class time?(Required)

Days of the week NOT available(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

I'm available ANY day

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:(Required)

I have read this release and understand it's meaning.

Signature of Parent or Guardian(Required)

Please Confirm