Just 4 Kicks Registration Form 2020/2021
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Email *
Child #1  Name (First, Last) *
DOB Child #1 *
MM
/
DD
/
YYYY
Age as of Dec. 31st 2020 *
Medical Conditions *
Age Division Child 1 *
Dance Classes you wish to register Child 1 *
Required
Child #2 Name (First, Last)
DOB Child 2
MM
/
DD
/
YYYY
Age as of Dec. 31st, 2020
Medical Conditions
Age Division Child 2
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Dance Classes you wish to register Child 2
Child #3 Name (First, Last)
DOB Child 3
MM
/
DD
/
YYYY
Age as of Dec. 31st, 2020
Medical Conditions
Age Division Child 3
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Dance Classes you wish to register Child 3
Parent/Guardians *
Mailing Address *
Phone Number *
Alt. Phone Number
Emergency Contact *
There is a costume deposit of $100 per class, due no later than November 20th. Any payments received after this date, will have a $10 late fee per class.
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I have read and understand the policies and procedures in effect at Just 4 Kicks, for Covid-19 and in case of shut down, understand that all classes will continue via Zoom. All classes will be made-up prior to June 25th, and will not continue into the summer. *
Required
Photography/Video: I give permission for my child's photos/videos to be used for advertising in the studio, on the Just 4 Kicks website, facebook/instagram page, and in the community *
I allow my child to attend classes at Just 4 Kicks Academy of Dance. I understand that there are some risks of personal injury or illness during classes, rehearsals, and performances outside of the Academy, and I will not hold Just 4 Kicks Academy of Dance legally responsible for any such injuries or illnesses. I understand that it is my responsibility to drop off and pick up my child at the scheduled class times, and that Just 4 Kicks is not under any obligation to care for my child when they are not in classes. I have disclosed all pertinent medical information regarding my child. *
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