Are you a new or returning student?
New
Returning
If you are new, how did you hear about us? If you are returning, what are any specific goals, suggestions, or things you are looking forward to this coming year?
Twirler's First Name
*
Twirler's Last Name
*
Twirler's Email Address (If they have one. If not, leave blank! )
Twirler's Cell Phone Number (If they have one. If not, leave blank!)
(xxx-xxx-xxxx)
Street Address
City
State
Zip code
Twirler's Age as of September 1, 2020
Twirler's Birthdate
-
Month
-
Day
Year
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Guardian's First Name
Guardian's Last Name
Guardian's Relationship
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Guardian's Email Address
Guardian's Cell Phone Number
(xxx-xxx-xxxx)
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Class / Team Registration
What would you like your involvement to be? (You may select all that apply)
*
Weekly Private Lessons ($25 for 1/2 hour; $40 for 1 hour)
Group Lessons (held Monday or Thursday with Miss Pam) (45 minutes per week, $60 a month)
Mini's Group Lessons (ages 0-5 held Monday with Miss Pam) (30 minutes per week, $50 a month)
Nationals Competitive Team (Sept - Dec 2020 - $95 - 1 in person choreography weekend per month, 1 virtual choreography weekend per month, 2 x 1 hour clinic weekends, 4 x 45 min dance classes) ; January 2021 - $110)
Intro Competitive Team ($40 per month will follow simplified version of Nationals Comp Team Schedule)
Would you like to schedule a regular private lesson?
Yes
No
If you selected yes, who would you like to schedule with? Please note all private lessons are to be paid in cash at time of lesson or before.
Miss Pam
PJ - https://www.signupgenius.com/go/4090f45afa62ca3fd0-2020
Jon - https://www.signupgenius.com/go/4090f45afa62ca3fd0-2020
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Medical Insurance Information
Medical Insurance Provider
Medical Insurance Policy Number / Group Number
Name of Policy Holder
Emergency Contact
Emergency Contact's Phone Number (xxx-xxx-xxxx)
Emergency Contact's Relationship to Twirler
Mother
Father
Step Mother
Step Father
Grandmother
Grandfather
Aunt
Uncle
Sister
Brother
Please list any known allergies.
I know of no reason(s), other than indicated on this form, why my child should not participate in twirling activities.
Sign here.
Clear
I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending The ShowTwirlers and that such exposure or infection may result in personal injury, illness, permanent disability, and death. By signing this agreement, I agree that my child and any accompanying persons will not enter The ShowTwirlers studio or a practice of any nature if we exhibit any of the following new or worsening signs or symptoms of possible COVID-19: A temperature greater than 100.4 degrees Fahrenheit, cough, shortness of breath or difficulty breathing, other respiratory symptoms, or at least two of the following symptoms: chills, repeated shaking with chills, muscle pain, sore throat, fatigue, headache, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, or new loss of taste or smell. I also agree that, neither my child(ren) nor any accompanying adult will enter if we have had known close contact with a person who is lab-confirmed to have COVID-19. The ShowTwirlers will maintain a strict cleaning and safety protocol. By signing this, athletes and their family members agree to follow guidelines while on premises.
*
Sign here.
Clear
I give permission to The ShowTwirlers to use photos taken of my child participating in twirling activities for the promotion of our studio and baton twirling.
Sign here.
Clear
I give my consent to the administration of emergency medical treatment by any licensed physician or dentist and to transport the child to any reasonably accessible medical / hospital facility. Initial below.
Sign here.
Clear
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Other Information About Twirler
T-Shirt Size
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Current School
Current Baton Size
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
I have no idea.
Current Shoe Size
Would you like to order any of the following?
Baton ($32)
Shoes ($44)
ShowTwirler Warm Up Jacket
Any additional comments, scheduling concerns, or things you would like Miss Pam, PJ, or Jon to consider? If you were with us last year, what is some feedback for us so we can continue to improve this coming year?
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Booster Club Support
Please pick 3 areas that you (the parent or guardian) would be willing to help with!
*
Holiday Party
Halloween Party
Parade Prep
Nationals Good Luck Party
End of Year Picnic
Webpage upkeep
Fundraising
ShowTwirler Gear Coordination / Ordering
Historian (photographer at events!)
Alumni Group Coordination
Twirl Fest Competition Prep
Little Buddy Program
PA State Teams Competition Prep
Exhibition Prep (Comp Team Only)
Camp Week Mom (Comp Team Only)
Competition Arrangements (Comp Team only)
Sponsorships (Comp Team Only)
Exhibition Raffle Baskets (Comp Team Only)
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Registration Fee
Registration Fee
*
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Registration 2020-2021
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40.00
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