J.E.M.S. Dance Center

(714)379-9700

6460 Westminster Blvd. Westminster, Ca 92683

(Cross street are Westminster Blvd. and Edwards Street)

 
 
 

They grow so fast!  Ryan and Naya then and now!

Custom

J.E.M.S. Dance Center Registration Form

(Please legibly print the entire form except the signature)

 

Student Name  _________________________________________________________________

Name of Parent/Guardian __________________________________________________________

 Address ______________________________________________________________________

(We need your complete address so we can keep you informed)

 Phone Number ______________________Emergency Phone Number ____________________

 How did you hear about JEMS? ______________________________________________

Which classes are you planning to enroll in? _____________________________________________ 

Please read and inital and sign below

I have received, read, and agree to abide by and be held accountable to all of the policies of J.E.M.S. Dance center. _______ I understand that there is some risk of injury associated with dance.  I agree to hold harmless and indemnify J.E.M.S. Dance Center and its owners, employees, and agents acting on its behalf in case of injury to the student.  I give my permission to any agent of J.E.M.S. Dance Center to obtain whatever medical attention they deem necessary for the student named above in the event of an injury.  I have full authority to authorize any and all medical attention without concurrence of any other individual.

 

Parent/Guardian Signature: ____________________________________Date ______________

 

Parent/Guardian Printed Name __________________________________

      

To print this information:  Hold down Control button and press P