TU LEFT FEET FALL 2020 REGISTRATION FORM

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-Only 1 student per registration form.
-Tuition may be paid in full or broken into 2 payments [ 50% October 5, 2020 + 50% November 5, 2020].
-Tuition previously paid for the months of April + May + June 2020 will be applied toward Fall 2020 Tuition.

Email *

Please select the 1st class you would like to register for: *

Please select the 2nd class you would like to register for:

Please select the 3rd class you would like to register for:

Please select the 4th class you would like to register for:

Student's 1st Name *

Student's Last Name *

Student's Date of Birth *

Student's Age *

Student's Current Grade Level *

E-Mail Address *

important updates, information, newsletters and closings will be sent to this address

Parent or Guardian Cell Phone *

(Emergency Contact)

Parent or Guardian's Name *

(Emergency Contact)

Alternate Phone *

what number do we contact if we can not reach the emergency contact listed above?

Secondary Parent or Guardian's Name *

who do we contact if we can not reach the emergency contact listed above?

Previous Experience *

please select any and all that apply

Ballet

Tap

Jazz

Lyrical / Modern / Contemporary

Hip Hop

Pointe

Gymnastics / Cheering

Dance Team / Color Guard

None

Other:

Required

Length / Location / Level of Previous Experience

this will help us determine the appropriate level and class for your child

Allergies, Previous Injuries, Illnesses, etc.

Release of Claims and Treatment Authorization

I am aware that dance, yoga, gymnastic and any physical exercise associated with it, place unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and/or myself, I assume this risk and agree that Tu Left Feet, LLC and its staff shall not be liable in anyway for the injuries sustained during attendance at the studio, located at 13214 Midlothian Turnpike, Midlothian, VA 23139 or any of its away functions. I grant my child/myself permission to participate in the fall 2020 season; and I release and discharge any claims, demands, actions, judgments, and executions to which the students, heirs, executors, administrators or assigns may have, or may claim to have against Tu Left Feet, LLC, its successors, its assigns for all personal injuries caused by, or from the above activities or any activities related. Further, I grant, Tu Left Feet, LLC and its employees permission to authorize any emergency medical treatment that may be required during the 2020 dance session.

Yes, I agree to and understand the above statement.

Clear selection

Photography Release *

I, the parent/guardian (or student, if 18+) authorize Tu Left Feet, LLC and/or its representatives, agents, or staff to use any photographs of my child (or myself), for any purpose, including publicity, choreographic archives, promotional materials and/or any other reason deemed appropriate by the artistic staff or marketing director.

Yes, I agree to and understand the above statement.

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