Fall Session Registration Form 2020-21

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6 Week Session

Email *

Additional email addresses in which you would like to receive important information

(use commas to separate email addresses)

Gender *

Female

Male

Prefer not to answer

Required

Birth Date *

YYYY

Age by first day of session *

Student Last Name *

Student First Name *

List any allergies and/or medical conditions you feel ATJ should be aware of

Street address *

Town *

Zip *

Parent 1 Name *

Parent 1 Phone *

Parent 2 Name

Parent 2 Phone

Emergency Contact Name

(other than above info)

Emergency Contact Number

(other than above info)

Emergency Contact Relation

New Student? *

Yes

Required

How did you hear about All That Jazz Dance Studio?

Returning Student

Instagram

Clipper Magazine

Drive by

Super Saturday

Washington Township Block Party

Referral

Other:

New students only. Did someone refer you All That Jazz? If so, who?

Other studio(s) or gyms attended

Any Prior Dance, Gymnastics/Tumbling, or Cheer Experience?

How many years of each style? What styles of dance?

Can All That Jazz Dance Studio use photos of student for advertisement purposes and social media? *

Yes

Required

Choose a class *

Ages 1-2 Saturday 10:00am

Ages 2-3 Saturday 10:45am

Required

Choose Session(s) *

6 Week Session $65 - Drop in Rate $15

$65 Session 1 9/19 - 10/24

$65 Session 2 11/7 - 12/12

$15 Drop in 9/19

$15 Drop in 9/26

$15 Drop in 10/3

$15 Drop in 10/10

$15 Drop in 10/17

$15 Drop in 10/24

$15 Drop in 11/7

$15 Drop in 11/14

$15 Drop in 11/21

$15 Drop in 11/28

$15 Drop in 12/5

$15 Drop in 12/12

Required

A credit will not be issued for any missed classes. No refunds once a session begins. There will be a $25 fee for any returned checks. *

I agree

Required

I agree to read and abide by the All That Jazz student handbook *

I agree

Required

WAIVER OF LIABILITY *

This agreement releases All That Jazz Dance Studio, LLC from all liability related to injuries that may occur on premises or during a performance. I agree to hold All That Jazz free from all liability including financial injuries incurred regardless of whether said injuries are caused by negligence. I also acknowledge the risks involved in dancing, cheer and gymnastics. I am participating voluntarily and all risks have been made clear to me. I agree that there are no pre-existing conditions that will increase my likelihood of experiencing injuries while engaging in these activities. I have read the terms above and understand them. I further understand that agreeing to this release, I voluntarily surrender certain legal rights.

I agree

Required

COVID-19 ACKNOWLEDGEMENT and DISCLOSURE WAIVER *

Please, complete waiver prior to first class. Failure to complete and agree to waiver will result in denied entry.

I affirm that student will not attend class/lesson at All That Jazz if student, or anyone in their household, show symptoms of the following. Fever of 100.4F or higher, sore throat, cough, sneezing, stomach/body aches, chest congestion, difficulty breathing, loss of taste or smell, or any other illnesses.

I affirm that participating student will not attend class/lesson if student/staff member, as well as other household members, has been diagnosed with COVID-19 in the last 30 days or has been tested for COVID-19 and is awaiting results unless provided with negative results after 14 days.

I affirm that participating student, nor other household members, have not knowingly been exposed to anyone with COVID-19 within the last 30 days.

I affirm that participating student, nor others in their household, has not traveled outside of the US or or was in a high covid case US state under the current Governor’s Travel Advisory within 14 days

I understand that All That Jazz Dance Studio is taking preventative measures for precaution.

I understand that All That Jazz Dance Studio and it’s staff cannot be held accountable for exposure to the COVID-19 virus.

Student and parties will adhere to all and any new guidelines presented at the studio while on the premises or will be asked to leave the building (see website for guidelines.)

I agree to waive any claims of liability against All That Jazz Dance Studio and hold All That Jazz Dance studio harmless if student is exposed to COVID-19 despite our best efforts. Additionally, I agree to notify All That Jazz Dance Studio if student or anyone in student’s household contracts COVID-19 or has come into contact with someone who tested positive for COVID-19. This action will help ensure the utmost safety of our students and staff.

I agree to notify All That Jazz Dance Studio if student or anyone in student’s household contracts COVID-19 or has come into contact with someone who tested positive for COVID-19.

Required

I am a parent/guardian of student under 18 years of age and agree to each statement above and release All That Jazz Dance Studio from any and all liability for unintentional exposure or harm due to COVID-19

Required

By typing my name below, I agree to each statement above and release All That Jazz Dance Studio from any and all liability for unintentional exposure or harm due to COVID-19

Today's Date

YYYY

Payments can be made by cash, check or credit/debit card. *

Registration is not complete and spot is not held until registration form and payment are submitted. See website for prices.

Credit/Debit Card

Cash

Check

Gift Certificate

Other:

Required

Credit Card Number

(no spaces)

Exp Date

CVV Code

Your chosen class may be full or student may be placed in another level/class. Once your registration form and payment is submitted, your form will be reviewed for approval and you will receive a confirmation email or phone call letting you know this class is reserved or another class is recommended. Schedule is subject to change. *

I agree

Required

Message

A copy of your responses will be emailed to the address you provided.

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