Register Below for Mizfit DanceDownload registration flyer for more information > Student Name * First Name Last Name Student Gender * Male Female Other Student's Birthdate * MM DD YYYY Student's Grade in School * i.e. Pre-K, Kindergarten, 1, 2, 3 Student's T-Shirt Size * S M L XL Aftercare or Pick-Up * Does your child go to aftercare or will you / another person pick up your child after school? Aftercare Pick-Up Authorized Pick-Ups If you selected 'Pick-Up' above, please provide a comprehensive list of people who are authorized to pick up your child Parent Name * First Name Last Name Parent's Email * Parent's Primary Phone Number * (###) ### #### Additional Phone Numbers Please provide additional phone numbers for individuals we should contact in the event the primary contact does not answer. Teacher Name * Notes for Teacher Session * Session 4 is $135 Session 4 Parent Waiver * I hereby release and agree to indemnify and hold harmless: MizFit, Inc., Palm Beach County Schools, Whispering Pines Elementary and all instructors from any liability and against any and all claims resulting from participation in this program, with my knowledge that by participating in this activity my child assumes risk of injury. I also hereby give permission to MizFit, Inc. to use and display any photographs taken of my child, which may be forwarded to newspapers and other publications in which the photograph would be associated with MizFit, Inc. I Agree Parent Signature * Please provide initials as a digital signature. How would you like to pay? * Online with Credit Card Offline NOTE: After pressing 'Submit', you will be redirected to a page with instructions for payment. Thank you!
