{"0":{"lid":"1531306243545","ls":"10","loff":"","li_type":"nm","li_title":"Student’s Full Name:","li_req":"y","li_nm":"Name"},"1":{"lid":"1531306540094","ls":"20","loff":"","li_type":"da","li_title":"DOB:","li_req":"y","li_dateformat":"DD-MM-YYYY","li_datediv":"dash","li_nm":"DOB:","li_datemask":"99-99-9999"},"2":{"lid":"1663297557020","ls":"30","loff":"","li_type":"in","li_title":"Address:","li_nm":"Address:"},"3":{"lid":"1663297603669","ls":"40","loff":"","li_type":"in","li_title":"City: ","li_nm":"City: "},"4":{"lid":"1663298418335","ls":"50","loff":"","li_type":"in","li_title":"State:","li_nm":"State:"},"5":{"lid":"1663298436564","ls":"60","loff":"","li_type":"in","li_title":"Zip code:","li_nm":"Zip code:"},"6":{"lid":"1663298455001","ls":"70","loff":"","li_type":"nm","li_title":"Guardian’s Name:","li_req":"y","li_nm":"Name_2"},"7":{"lid":"1663298674023","ls":"80","loff":"","li_type":"ph","li_title":"Cell Number:","li_req":"y","li_masktype":"a","li_maskcountry":"US","li_nm":"Phone"},"8":{"lid":"1663298709913","ls":"90","loff":"","li_type":"in","li_title":"Relationship to Dancer:","li_req":"y","li_nm":"Relationship to Dancer:"},"9":{"lid":"1663298737082","ls":"100","loff":"","li_type":"em","li_title":"E-mail:","li_req":"y","li_nm":"Email"},"10":{"lid":"1663298752808","ls":"110","loff":"","li_type":"ta","li_title":"List any medical conditions/allergies:","li_rows":"3","li_nm":"List any medical conditionsallergies:"},"11":{"lid":"1663298804259","ls":"120","loff":"","li_type":"in","li_title":"Person to contact beside parent/guardian in case of emergency:","li_nm":"Person to contact beside parentguardian in case of emergency:"},"12":{"lid":"1663299025639","ls":"130","loff":"","li_type":"cb","li_title":"Please check if you give permission to have your child’s picture to be taken and put up on our website, Facebook, programs, and other items.","li_label":"<div style=\"font-size:18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; font-weight: 400;\">I agree</span></div>","li_nm":"Please check if you give permission to have your childs picture to be taken and put up on our website Facebook programs and other items."},"13":{"lid":"1663298826665","ls":"140","loff":"","li_type":"tx","li_text":"<div style=\"font-size: 18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student represents that he or she is in good physical condition and able to participate in the exercises recommended by Construct Breakin.</span><br /><br /><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student fully understands and agrees that in participating in one or more classes or using the facilities provided by Construct Breakin there is possibility of accidental injury. </span><br /><br /><span style=\"font-family: Montserrat; color: rgb(158, 158, 158); font-weight: 400;\">Student further agrees to indemnify Construct Breakin from any accidents, injuries, or losses incurred on Construct Breakin’s property.</span></div>"},"14":{"lid":"1663299193660","ls":"150","loff":"","li_type":"tx","li_text":"<div style=\"font-size: 18px;\" data-customstyle=\"yes\"><span style=\"font-family: Montserrat; font-weight: 400; color: rgb(0, 0, 0);\">By signing below, you agree to pay for tuition each month, required attire, and any other fees that may be incurred</span></div>"},"15":{"lid":"1663299307714","ls":"160","loff":"","li_type":"nm","li_title":"Full Name","li_req":"y","li_nm":"Name_3"},"16":{"lid":"1663299807446","ls":"170","loff":"","li_type":"da","li_title":"Date:","li_req":"y","li_dateformat":"DD-MM-YYYY","li_datediv":"dash","li_nm":"Date:","li_datemask":"99-99-9999"}}
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