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: *
Additional (Emergency) Contact Info*
Students entered below will be added to your family's account
Additional Information:
Release of Liability:
I agree to assume all risks incidental to my child's participation in dance activities and I hereby release JMD Studios LLC from any and all liabilities, claims, actions, damages, costs, and/or expenses arising from or in any way connected with my child's participation in all activities conducted. I hereby agree that JMD Studios LLC, its owners, officers, and instructors are not in any capacity personally responsible or liable for any injuries or damage resulting from my child's participation in any JMD Studios LLC class and acknowledge and assume any and all risk associated with this activity.

Medical Treatment:
I understand that in case of an emergency every attempt will be made to contact me directly, but if I am unable to be reached, I give JMD Studios, LLC permission to authorize my child to be medically treated in an emergency.

Marketing Release
I give permission for the images of the participant to be used in JMD Studios, LLC ads, promotional videos, website material, or various other marketing media. These images will be used for JMD Studios, LLC purposes only, and will not be given or sold to outside companies or individuals.

I've read the above and agree.
I understand that the fees for this event will be charged to my account / card on file one week prior to the event I am signing up for & that these fees are non-refundable.

I may withdraw from the event prior to the one week deadline by e-mailing

I understand if the event is not paid for in full one week prior then my spot will be lost.

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:*