TU LEFT FEET SUMMER 2019 REGISTRATION FORM
*Only 1 student per registration form.
*Tuition is due at your child's 1st class.
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Email *
Please select your 1st choice class:
Please select your 2nd choice class:  
Please select your Mom's Morning Out days:
Student's 1st Name *
Student's Last Name *
Student's Date of Birth *
Student's Current Grade Level *
grade level 2019-2020 school year
E-Mail Address *
important updates, information, and receipts will be sent to this address
Parent or Guardian Cell Phone *
(Emergency Contact)
Parent or Guardian's Name *
(Emergency Contact)
Secondary Parent or Guardian's Name *
who do we contact if we can not reach the emergency contact listed above?
Alternate Phone *
what number do we contact if we can not reach the emergency contact listed above?
Physical / Billing Address *
street, city, state, zip
Release of Claims and Treatment Authorization *
I am aware that dance, cheer, 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 2656 Anderson Highway, Powhatan, VA 23139 or any of its away  functions.  I grant my child/myself permission to participate in the 2019 summer 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 2019 dance session.
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.
Previous Experience *
please select any and all that apply
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.
Sibling Registered @ Tu Left Feet? *
(if "yes" please provide sibling's 1st + last name in the "other" box)
A copy of your responses will be emailed to the address you provided.
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