Summer Registration Form
Email address *
Student's Name *
Your answer
Student's Birthday (MM/DD/YY) *
Your answer
Student's Grade *
Guardian's Name *
Your answer
Address *
Your answer
Preferred telephone number *
Your answer
Classes interested in *
Required
How did you hear about us? *
I agree: I, the undersigned, the applicant, for and in further consideration of the dance center accepting said applicant, hereby agree to save and indemnify and keep harmless the said Ideal Dance, its agents, sponsors against any and all liability, claims, judgments or demands for the damages arising as a result of injuries sustained by the applicant during or as a result of any course of instruction given the applicant by the dance center. *
Media Policy: I hereby give Ideal Dance permission to print, photograph, and record me/my child for use in video, film, or any other electronic, digital media. 1.This is with the understanding that neither Ideal Dance nor its representatives will reproduce said photograph, video, or likeness for any monetary gain. I am also fully aware that I will not receive monetary compensation for my child’s participation. 2. I further release and relieve Ideal Dance and its employees, from any liabilities, known or unknown, arising out of the use of this material. We will never attach names to these pictures or videos, and will remove any other “tags” that other people place. *
Please type your name as an electronic signature for the information above *
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