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MENTORING YOUTH AND AFFECTING THEIR FUTURES
Dance Troupe Signup
Parent First name
Parent Last name
Parent Email
Phone
Address
Dancer 1 - First and last name
Dancer 1 - Birthdate
Dancer 1 - Grade for 2023-24 school year
T-shirt size
Do you have another dancer to register?
Yes
No
Dancer 2 - Grade for 2023-24 school year
Dancer 2 - Birthdate
Dancer 2 - Grade for 2023-24 school year
T-shirt size
Do you have another dancer to register?
Yes
No
Dancer 3 - First and last name
Dancer 3 - Birthdate
Dancer 3 - Grade for 2023-24 school year
T-shirt size
I grant Les Clay my permission to use the photographs and videos of my child(ren) taken during any Nuru event for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Agree
Disagree
In the event of an emergency, I give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency and you are unable to reach me at the above numbers, contact:
You should be aware of these special medical conditions of my child(ren):
Your Signature
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Yellow - $75
Green & Red - $100
Blue & Black - $125
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LIGHT SHINE BRIGHT
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NURU KIDS
Nurturing and empowering children as the trailblazers of a brighter future
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