Dancer 1, name: *

First Name

Last Name

Dancer 1, date of birth: *

MM

DD

YYYY

Dancer 2, name:

First Name

Last Name

Dancer 2, date of birth:

MM

DD

YYYY

Parent / Guardian, name: *

First Name

Last Name

Phone / Cell: *

(###)

###

####

I'm interested in classes: *

1X a week

2X a week

3X a week

Waiver to participate: *

I agree not to hold Katie Jamieson and/or Jamieson Irish Dance liable for any injury, accident or loss while participating in any dance activity. If injury occurs, I understand that medical bills & other inconveniences of the injury will be handled by the parent/guardian. I also confirm that my child/children are of healthy standing & are permitted to participate in dance/exercise. I understand how sicknesses/viruses are contracted & am fully aware of the risks associated in a dance class environment. I will not hold Katie Jamieson and/or Jamieson Irish Dance liable for any sickness/virus contracted at any time. Prior to arriving to class I have assessed my dancers health & observed for any symptoms-if feeling ill, my dancer(s) will stay home. I understand all terms regarding payments & agree to make payments by scheduled dates or pay the appropriate late fees. If a check is returned a $25 fee will be added. There will be no refunds if a student misses class regularly. If a student would like to leave the dance school, a 30 day notice should be given in writing, otherwise monthly charges will continue, Thank you.

Yes

Social Media Waiver: *

I approve the use of photographs of my child/children to be used in an advertising manner, ie: website, pamphlets, Social Media posts, etc.

Yes

No