Fairy Tales in Motion
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 Registration Form Classes and Camps 2018

Student’s Name_________________________

Age_____Sex____Child’s Date of Birth__________________

Parent’s Name____________________

Home Phone______________________

Cell Phone____________________



Email Address_____________________________

                        (Please write legibly!)

Class/Camp Code:

1st choice______2nd choice_______

I, ___________________________________

have enrolled my child __________________

in a program of physical activity including but not limited to creative

movement and or Ballet/Jazz.

I hereby affirm that my child is in good physical condition and does not

suffer from any disability that would prevent or limit his/her

participation in this program.

I, __________________________

for my child, myself, my heirs and assigns release Fairy Tales in

Motion (it’s (and it’s members and owners) from any claims, demands

and causes of action resulting from any participation in the dance program.


Parent or guardian’s signature and date

Please mail this form along with check for payment in full to:

Jan Taylor
P.O. Box 51
Brookeville, MD 20833