Directors:

Brooke Miller & Lisa-Marie Jensen

Upper Valley Idaho LLC

103 North 1800 East Rexburg, ID 83440
lisamarieandbrooke@gmail.com

208-359-9749
208-227-4264

* REGISTRATION FORM * FALL 2012/SPRING 2013*

Parents Name: _______________________________________________ E-mail Address: __________________________________________
Phone Number: _______________________________________________ Cell Number: ____________________________________________
Mailing Address _______________________________________________________________________________________________________
Emergency Contact Name and Number: ___________________________________________________________________________________
*Our main/only mode of contact will be through first, e-mail and secondly, text message. Do you check either on a regular/daily basis?
Yes

No

If no, what is the best way to contact you? ___________________________________________________________________

How did you hear about us?_________________________________________________________________________________________________________________________

STUDENTS TO ENROLL: (Please use back of page if additional space is needed.)

1. Name: ____________________________________________ Age and Grade: ___________ Session Preferred:________________________
Any concerns (Special needs, food allergies, etc.) ____________________________________________________________________________
2. Name: ____________________________________________ Age and Grade: ___________ Session Preferred:________________________
Any concerns (Special needs, food allergies, etc.) ____________________________________________________________________________
3. Name: ____________________________________________ Age and Grade: ___________ Session Preferred:________________________
Any concerns (Special needs, food allergies, etc.) ____________________________________________________________________________

SESSIONS AVAILABLE

Boogie Beats 1 Ages 4-6 4:10-4:55 p.m.

Boogie Beats 2 Ages 6-8 5:15-6:00 p.m.

Rhythm Rockers 1 Ages 8-10 4:00-4:55 p.m.

Rhythm Rockers 2 Ages 10-12 5:05-6:00 p.m.

All Boogie Beat and Rhythm Rocker classes will be held on Mondays at the FUZION Studio. 225 N. Railroad Ave. Sugar City
All class ages/sessions are flexible according to the needs of the child and family. All requests will be considered and we will do our best to accommodate them.

TaVaci TOTS Mommy and Me Class Ages 2-4

Tuesdays 10:20-11:00 a.m. Rexburg Chamber of Commerce Event Room

*All TaVaci classes will begin the week of September 10th *

*A letter/e-mail of welcome will be sent to all TaVaci students/families prior to the start of the semester as a reminder of start date and other important, helpful
information.*
Please mail registration form and registration fee to:
Lisa-Marie Jensen 103 North 1800 East Rexburg, ID 83440
Checks Payable to: TaVaci

I have read and understand TaVaci policies and procedures. I release, discharge, and covenant not to sue TaVaci
Upper Valley Idaho, LLC for any reason or purpose due to any situation, including negligence.
Parent/Guardian Signature

_____________________________________________________________Date_________________