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Please fill out ONE FORM per Dancer/Tumbler

Birthday
Dancer/Tumbler age
Classes ages 2-6
Classes ages 7-10
Classes ages 11-14
Classes ages 15-18
Specialty Classes
Billing Options:
Pay in full
Monthly

In case of illness or injury and a parent cannot be reached, the staff of Shuffles Studio of Dance, LLC may authorize medical treatment for the above-named student. I understand that because dance and tumbling involves motion, there is a risk of injury. I and my heirs hereby release Shuffles Studio of Dance, LLC and its employees, instructors, and owners from liability for damages and/or injury or medical expenses which might occur as a result of my child's participation. My child has no problems that might compromise his/her safe involvement. Shuffles Studio of Dance, LLC may use photos of participants for promotional purposes. By registering for one or more of our programs, you have granted permission to use your child's photograph for promotional use unless otherwise noted.

Date Signed
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