J.E.M.S. Dance Center Registration Form
(Please legibly print the entire form except the signature)
Student Name _________________________________________________________________
Name of Parent/Guardian __________________________________________________________
Address ______________________________________________________________________
(We need your complete address so we can keep you informed)
Phone Number ______________________Emergency Phone Number ____________________
How did you hear about JEMS? ______________________________________________
Which classes are you planning to enroll in? _____________________________________________
Please read and inital and sign below
I have received, read, and agree to abide by and be held accountable to all of the policies of J.E.M.S. Dance center. _______ I understand that there is some risk of injury associated with dance. I agree to hold harmless and indemnify J.E.M.S. Dance Center and its owners, employees, and agents acting on its behalf in case of injury to the student. I give my permission to any agent of J.E.M.S. Dance Center to obtain whatever medical attention they deem necessary for the student named above in the event of an injury. I have full authority to authorize any and all medical attention without concurrence of any other individual.
Parent/Guardian Signature: ____________________________________Date ______________
Parent/Guardian Printed Name __________________________________
To print this information: Hold down Control button and press P
