Register Below for Mizfit Dance Student Name * First Name Last Name Student Gender * Male Female Other Student's Birthdate * MM DD YYYY Student's Grade in School * NOTE: For KINDERGARTEN, write "K"; for FIRST GRADE, write "1", for SECOND GRADE, write "2", and so forth... 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 Parent Waiver * I hereby release and agree to indemnify and hold harmless: MizFit, Inc., Palm Beach County Schools, Donna Klein Jewish Academy 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!
