July 24th Tumbling for Dancers Registration (all fields must be filled out) Parent or Guardian Name:* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Second Contact Information (as needed) Dancer's Name* First Last Dancer's Birthdate* Month Day Year May we have permission to use your child(rens)’s image in publicity online (social media and website) and in print?* Yes No Please read and accept the Assumption of Risk form.I have read and accept the Assumption of Risk* ACCEPT Is there anything we need to know about your child(ren)?Other comments:
