Register Agreement

Joy of Movement Dance Center - 215-262-0637
Redeemer Luthern Church Hall, 2100 York Road, Jamison, PA 18929

Thank you!

Thank you for registering online, your PayPal payment has been received.

To complete your registration, please complete the Registration Agreement form below. If you have any questions, please contact Miss Shannon at 215-262-0637 or email us.

Please Note: All information is required!

Registration Agreement

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Contact Information

Name (of dancer):

Age:

Date of Birth:

Parent(s) name:

Address:

Home phone:

Cell phone:

Parent email:

Emergency contact/phone:

Any medical conditions:

Class Selection(s)

Class Day:

Time:

Teacher:

Class Day:

Time:

Teacher:

Class Day:

Time:

Teacher:

Class Day:

Time:

Teacher:

Class Day:

Time:

Teacher:

Agreement

*I, the undersigned agree to release and hold harmless of all liability Joy of Movement Dance Center, LLC, its employees and volunteers from any claim, demand or cause from injury to the above named participant or damage to his/her personal property which is in any way connected to Joy of Movement Dance Center, LLC programs and hereby acknowledge that you are knowingly and voluntarily assuming full responsibility for all risks of physical injury arising out of active participation in a dance class or any other dance related activity. I understand there are no refunds for any registration fees, costumes, date nights or classes. I understand that my child must have this release signed before attending class.

Parent signature:

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