JTLD Back to School Registration Form

(NOTE: An Adult and all children must be present to receive backpacks)

First Name (Parent/Guardian)

Last name (Parent/Guardian)

Phone

How Many Children

Email

By signing below, I acknowledge and accept that participation in any physical activity or event associated with JT Line Dancers of Little Rock, Arkansas, Inc. involves a risk of injury. I agree to assume all responsibility for any such risk and hereby release and hold harmless JT Line Dancers of Little Rock, Arkansas, Inc., its officers, instructors, and affiliates from any and all liability for injuries, losses, or damages incurred while participating in any related activity or event.