Fall Registration

Fall Registration

Beginning August 27th 2025 at The School of Dance
Twirler's Name*

First NameLast Name
Parent/Guardian's Name*

First NameLast Name
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
E-mail*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Twirler's Birth Date

MonthDayYear
Date
Twirler's Age
Twirler's Gender

MaleFemaleOther
Emergancy Contact Information

Full NameRelationPhone Number
List any medications, allergies, or medical conditions that we should be aware of.
How did you hear about us?
If applicable, please input the first and last name of the person who referred you.

First NameLast Name

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Liability Release Form and Assumption of Risk
I/we realize that participation in baton twirling classes and activities could result in some possible personal injury. Despite precautions being taken by the studio, accidents and injuries may occur. By signing this release form, I/we (the twirler and parent/guardian) assume all risks related to the use of any and all spaces used by Salt Lake City Twirlers.*

I agree.I do not agree.
I/we agree to release responsibility from the Salt Lake City Twirlers. This includes all teachers, staff members, twirlers, and facilities from any cause of action, claims, or demands now and in the future. I/we will not hold Salt Lake City Twirlers liable for any personal injury including: scrapes, bruises, cuts, sprains, fractures, broken bones, concussions or death or any personal property damage/loss, which may occur on the premises before, during or after classes.*

I agree.I do not agree.
Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Salt Lake City Twirlers.*

I agree.I do not agree.
In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to Emily Jansen, owner of the Salt Lake City Twirlers as soon as possible.*

I agree.I do not agree.
PHOTOGRAPHY/VIDEO – I give permission for my son/daughter’s photographs/videos to be used for publicity and advertising in the studio, on the Salt Lake City Twirlers social media accounts, and in the community.*
Twirler's Name*

First NameLast Name
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian Sign and Date*

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Fall Registration

Billing Information

Liability Release Form and Assumption of Risk