Registration For 2017-2018 Classes Note: Classes for the 2017-2018 year begin on September 5. Please fill in all of the fields below to complete your registration. Registration Procedure 1. Fill out and submit the online form to reserve your class spot 2. Final step that holds your spot in class is printing the Waiver and Release Form, signing it and returning it with the first month's paid tuition. 3. Mail Waiver and Release form AND 1st month tuition to: Jen’s Academy 324 North Road Butler, Pa 16001 You will receive a confirmation email from Ms. Jen once she receives your online registration and she will confirm that you signed up the right classes and let you know your monthly tuition total. You can also stop by the studio on Tuesdays, Wednesdays, and Thursdays from 5:00pm to 8:30pm during the month of August to fill out the Waiver and pay in person by cash, credit card or check. Mailing Address: 324 North Road Butler, Pa 16001 Jen’s Academy of Rhythm & Moves Registration 2017-2018 If you submit a registration and do not receive an email confirmation from Ms Jen within 48 hours, please call her or message her on Facebook, as we seem to be having some delivery issues.Participant's Name* First Last Male or Female*MaleFemaleAge*Date of Birth*Best Phone Number*(###) ###-####Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Address* Parents/Guardian's Name* First Last Insurance Carrier*Policy Number*Primary Doctor*1st Emergency Contact Name* First Last Relationship*1st Emergency Contact Phone Number*2nd Emergency Contact Name* First Last Relationship*2nd Emergency Contact Phone*Please list and explain any special health problems or needs your child hasCheck the SCHEDULE PAGE and list all classes you are interested in, and Ms. Jen will be in touch with you. You MUST list class name, day and time, and teacher for EACH CLASS that you are interested inClasses Interested In*Check the SCHEDULE PAGE and list all classes you are interested in, and Ms. Jen will be in touch with you. You MUST list class name, day and time, and teacher for EACH CLASS that you are interested inExperienceFor each class that you checked and plan on taking please write your experience (# of years of formal class training, any competing, show participation, skills you have…) and your ability level (Novice, Beginner, Intermediate, Advanced). These are the IMPORTANT DATES that you need to be aware of for the 2017-2018 year. September 5 - Classes Start September 10 - Kick-Off Party (1 pm - 4 pm) October 15 - Perform For The Cure Breast Cancer Awareness Fundraiser November 23 - CLOSED Thanksgiving Day only December 24 - January 1 - CLOSED for Christmas Break March 31 - 5 Star Performers Craft & Vendor Show at SRU March 31 - Baton and Dance Competition at SRU May 6 - Picture Day (MANDATORY noon - 8pm) May 18 - Dress Rehearsal (4:30 pm - ?) May 19 - Recital (MANDATORY Stage Photo - 1:30 pm, Show at 3:00 pm) June 16 - 5th Annual I'm A Star Pageant NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.