Enroll — Legacy Moko Jumbies

👤Section 1: Member Information

FULL NAME

DATE OF BIRTH

AGE

If under 18, a parent/guardian must complete Section 2.

Only complete the two fields below if you are 18 or older.

MEMBER PHONE (18+)

MEMBER EMAIL (18+)

👥Section 2: Parent / Guardian Information

Required if member is under 18.

PARENT / GUARDIAN NAME

RELATIONSHIP TO MEMBER

PHONE NUMBER

EMAIL ADDRESS

🎭Section 3: Package Selection & Sizing

SELECT YOUR PACKAGE

Experienced Moko Jumbie — $500

2 Costumes · 2 Dry-Fit Shirts · Stilts Bag · Gloves · Mask · Duffle Bag

New Moko Jumbie — $600

Brand New Stilts · 2 Costumes · 2 Dry-Fit Shirts · Stilts Bag · Duffle Bag · Fulani Hat · Gloves · Mask

T-SHIRT SIZE (UNISEX)

HEIGHT (FT)

HEIGHT (IN)

SHOE SIZE

Crucial for stilt-making & foot-straps.

💸Section 4: Discounts & Payments

PARTICIPATING WITH A FAMILY MEMBER?

YesNo

DID SOMEONE REFER YOU TO LMJ?

YesNo

WHO DID YOU REFER TO JOIN THE GROUP?

Earn $25 off per person who signs up.PAYMENT PREFERENCE

Paid in FullRequesting a Payment Plan

⚠️Section 5: Emergency Contact & Medical

EMERGENCY CONTACT NAME

RELATIONSHIP

PHONE

MEDICAL CONDITIONS, ALLERGIES, OR PREVIOUS INJURIES?

✍️Section 6: Liability Waiver & Photo Release

Moko Jumbie stilt walking involves physical activity and heights. Safety is our #1 priority, but proper caution must be exercised.

Liability Waiver: I understand that stilt walking carries inherent risks. I agree that Legacy Moko Jumbies, its instructors, and organizers are not liable for any injuries sustained during practice, performances, or events.Photo/Video Release: I grant permission to Legacy Moko Jumbies to use media (photos/videos) featuring myself/my child for promotional and social media purposes.Medical Emergency Consent: I give Legacy Moko Jumbies permission to seek medical attention for myself/my child in the event of an emergency.

SIGNATURE (PARTICIPANT OR PARENT/GUARDIAN)