Summer Camps Registration Parent's InformationParent Name* First Last Home Phone*Mobile PhoneParent Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dancer's InformationDancer's Name* First Last Dancer's Age*Choose From the Dropdown34567891011121314-18Adult (19+)Birthday* Gender*Choose From the DropdownMaleFemalePrefer Not to AnswerAre you a returning student?*Choose from the options belowYes, I have taken classes with Jazz N TapsNo, this is my first time with Jazz N TapsSummer CampsThe camps listed below are for the Summer only. Regular Fall classes will resume in August.Summer CampsChoose the camps below that your dancer would like to register for. Moana Camp 1: June 12-15 Moana Camp 2: June 26-29 Trolls Camp 1: June 19-22 Trolls Camp 2: July 10-13 Jaz N Taps WaiverREQUIRED: * **** [Please check the box below to agree to the waiver. Dancer may not participate without agreeing to this waiver. Thank you.]**** I hereby agree to indemnify and hold Jazz n Taps Dance Studio, its owners and employees and any community organization co-sponsoring the program from and against any and all liability for any injury or property loss sustained by participant or his/her family arising out of or in any way connected with participation in the Dance program named above. CONSENT: I so hereby grant authority to the staff at Jazz n Taps Dance Studio to render a judgment concerning medical assistance for my child in the event of an accident or illness during dance class or Jazz n Taps dance related activity. I also do hereby authorize Jazz n Taps Dance Studio and its assigns to utilize any and all photographs or film as they deem appropriate in its promotional materials or dance films. My agreement below indicates that I am aware of and understand how this Dance program will be conducted.* YES, I agree If there is anything you would like to add, please write below. This iframe contains the logic required to handle AJAX powered Gravity Forms.