Jewels Twirling Academy

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Registration Form 2022

Please fill out the complete form

Jewels Academy

Child's First Name

Child's Last Name

Date of Birth

Grade

School

Parent's First Name

Parent's Last Name

Parent's Email

Parent's Cell Phone Number

Emergency Contact Name and Cell Phone

Who referred you to the program?

First Name

Last Name

Special Abilities Child:

Special Abilities Parent:

Business: (if applicable)

I have read and agree to the Release / Waiver

RELEASE / WAIVER

In consideration of my child being allowed to participate in the twirling academy at Brownsville Middle School, New Mt. Moriah, Holmes Elementary, Hadley Park, the YWCA, Carter Park Gym, Oswald Park and other locations by Jewels Twirling Academy, I the undersigned, hereby agree that:

The risk of injury to my child may be significant if safety techniques are not properly adhered to. For myself and my child I assume full responsibility for my child's actions and participation. I (we) willing agree to comply with the rules and conditions for the academy and accept the risk of injury if my (our) child participates.

Parent Signature (by typing name you agree to electronic signature)

My child has permission to be photographed/video taped for advertising and or promotional purposes (Select One)

My child can leave the facility with the following people

Phone/Mobile

Meet The Owner

Tanya Jackson

Certified Florida Bandmasters Association Judge * Director of National Champion Jewels Twirling Academy,Former Bethune Cookman College Cheerleader * Former Miami Northwestern Majorette,Executive Pastor of New Mount Moriah Missionary Baptist Church * Community Coalition Builder*

YOUTH ENTHUSIAST EXTRAORDINAIRE

From the depths of South Florida, Tanya has over 22 years of experience in grooming children to perform and achieve. Starting out from a small vision, Mrs. Jackson has grown to serve thousands of children by "edutaining" them and instilling excellence.

Motto: Stay on Ready
Experience: 22 Years

Performance Rule #1
TACTFULLY OVERDO IT!

Registration Form 2022

Tanya Jackson

Contact
Tanya Jackson, Artistic Director

Phone number
(786) 357-4939

Email address
jewelson3@gmail.com

Jewels Twirling Academy

Enrollment Expires

Registration Form 2022

Tanya Jackson

ContactTanya Jackson, Artistic Director

Phone number(786) 357-4939

Email addressjewelson3@gmail.com

Contact
Tanya Jackson, Artistic Director

Phone number
(786) 357-4939

Email address
jewelson3@gmail.com