F/E Dance Class Registration                                   2023/2024
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Name of Dancer: (First & Last)
(One form per Dancer please)
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Dancer's Date of Birth ( Month, Day, Year)  *
MM
/
DD
/
YYYY
 Dancer's age as of September 1, 2023 *
Name of Parent & Contact information - 
Current email and phone number are required. 

Email is the studio's primary method of contact, so please ensure that you add info@ferguseloradance.com to your safe sender list)
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Emergency Contact Name & Number:
(as well as their relationship to the student)
 *
Medical Conditions/Concerns: 

For your Dancer's safety, please list any or all conditions that we should be made aware of.  

If your Dancer requires an epi-pen, please ensure that they have this with them for each class. 
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Class selection: 
(Please select applicable choices) - Click Link To View Schedule https://shorturl.at/lqCY0


Ages are approximate
 *
Required
            WAIVER OF LIABILTY - PLEASE READ & SIGN

                                 Waiver of Liability

I understand that dance is involve potentially dangerous techniques and by signing below, I accept all risk of injury as my own personal liability. I understand that there are risks inherent in any physical fitness program and I accept these risks as my own personal liability. I affirm that I am in good health, capable of safely participating in cardiovascular activity and I accept as my personal risk the consequences of such participation. I understand that it is always wise to consult a physician before starting any physical fitness program. 

In the event that I become injured or ill during the participation in this program, I authorize any representative of Fergus Elora Academy of Dance to act on my behalf to seek medical attention. I agree to follow all safety instructions and other rules of any instructor teaching programs at Fergus Elora Academy of Dance. I affirm that my dancer(s) will not participate in any dance program under the influence of drugs, alcohol or other substances that may impair their ability to do dance activities and classes safely. 

I understand that Fergus Elora Academy of Dance and The Owner/Artistic Director, Erica Finlayson-Marak and current and former Instructors, accept no responsibility for any injury, financial liability or damages due to injury or accident or other unforeseen incident occurring during or after any program in any location where the program is being held. The participant or, if applicable, the legal guardian, accepts all risks and financial liability resulting from injury, accident or other unforeseen incident occurring during or after any program sponsored by Fergus Elora Academy of Dance in any location where the program is being held. If applicable, I authorize the use of photos of my Dancer(s) to be used in print or on the web for promotional purposes.

If the student is under 18 years old, I am authorized to provide consent for the person named in the registration form to participate in this program. I understand the risks defined above. I certify that I am authorized to release personal information on the student's behalf. If applicable, I authorize the use of photos of my child to be used in print or on the web for promotional purposes.

                PLEASE PRINT NAME AND DATE BELOW!

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