We invite all of our performers from our Children's Division age 3 and up (by January 1, 2019) to participate. ~ Please Note: If you enter a different credit card than that which is on file, the system will automatically change your card on file to the one you are providing. Please go to your portal and make sure the card on file is the one you wish to use.
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Students entered below will be added to your family's account
Full name of Daddy or Significant Male Figure:*
Additional Information:
Release of Liability
As the legal parent or guardian, I hereby release and hold harmless Mary Jo's Performing Arts Academy, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or in route to or from any of said premises. I understand that appropriate physical contact is required during the instruction of dance, and I give permission for instructors to make appropriate physical contact with me or my child for such instruction.
I understand Mary Jo's Performing Arts Academy reserves the right to refuse my business without notice.

I've read the above and agree.
Assumption of Risk
In case of emergency or sudden illness, I hereby give permission for a staff member of Mary Jo's Performing Arts Academy to authorize any physician, nurse practitioner, medical personnel or hospital to render immediate emergency aid as it might be required for the undersigned participant's/participants' health and safety.
I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant(s) to be in good physical and mental health.
It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the participant(s) own policy is the only source of reimbursement.

I've read the above and agree.
Photo and Video Release
I understand and acknowledge that, from time to time throughout the year; the participant(s) may be photographed and/or videotaped while participating in functions involving MJPAA. I do hereby authorize Mary Jo's Performing Arts Academy to use these photographs and videotapes for the purposes of illustration, advertisement and publication in any manner whatsoever.
I've read the above and agree.
Rehearsal & Costume Agreement
I am aware of the rehearsal schedule below and realize that attendance to rehearsals is very important . I am also aware that only one rehearsal may be missed and Dress Rehearsal is mandatory.

Rehearsals will be held on the following dates:
Saturday, March 30th
Saturday, April 27th
Saturday, May 18th
Saturday, May 25th
Saturday, June 1st

All rehearsals are closed.

I am aware that daughters will need to wear a white dress, tan tights & pink ballet shoes and daddies will need to wear dark dress pants, a white button down shirt & dark dress shoes for the performance.

I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*