SUMMERREGISTER_TEMP

Student Name *

First

Last

Date of Birth *

Age *

Daytime Classes

Evening Classes

5:30-6:30 *

None Combo - Thunder and Laser

6:30- 7:30 *

None Combo - Lazer/Bionic/Sonic STJ Atomic/Elite

7:30-8:30 *

None Combo - Bionic/Sonic/Atomic/Elite

Parent/ Guardian Name *

First

Last

* Indicates required field

Primary Email *

Primary Phone Number *

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Please specify any special conditions or allergies. *

Medical Consent *

I Agree

Media Release *

I Agree

I approve of my child’s participation in Vibe Performing Arts programs, and certify that he/she is in good health and able to participate in the program. If medical attention is required for illness or injury, I grant permission for such care to be rendered.

I authorize images and videos to be posted on websites and social media that may be taken during events coordinated through Vibe Performing Arts.

Summer Intensive Registration

Daytime Classes

Evening Classes

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