Schedule a Coaching Session
Schedule a Session
Email *
Student Name *
Student Date of Birth *
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Parent Name *
Parent Phone *
What times are the student available?
Please select all that apply
Morning
Midday
Afternoon
Evening
Monday
Wednesday
Thursday
Friday
Sunday
Goals of the student
I agree to abide by CDC and EnCroix Movement Standards of Healthy Practices when in person. *
Required
Liability Waiver
We (Parent and Student) agree to healthy practices and we acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
We further acknowledge that EnCroix Movement has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that EnCroix Movement can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to staff, and other students and their families.
I voluntarily seek services provided by EnCroix Movement and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending the workshop.
I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to holdEnCroix Movement and 2155 Ballroom and Events harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act, or that may otherwise arise in any way in connection with any services received from EnCroix Movement. I understand that this release discharges EnCroix Movement and 2155 Ballroom and Events from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from EnCroix Movement. This liability waiver and release extends to EnCroix Movement and 2155 Ballroom and events together with all owners, partners, and employees.
Sign Liability Waiver *
Tuition
Tuition *
Tuition Cost: I understand that by registering I am committing to paying the following fees before attending classes/sessions. *
Required
Monthly Group Classes Also Offered *
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