Registration & Release Form | Showtyme Xtreme Athletics & Dance

Student's Name*

First Last

Date of Birth*

Parent's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone*

Cell Phone*

Work Phone

Emergency Contact Name*

Emergency Contact Phone*

Interested in*

Fall Session

Classes desired to enroll in:

Choose all that apply:

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*