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____________________


Address__________________________


City______________St____Zip_______


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
240-505-8253