GeneRaTion DCD Fall 2017 Trial Class Registration/Waiver form
Email address *
TRIAL PRE-K CLASSES for FALL 2017
PLEASE FILL OUT 1 FORM PER CHILD!
Please fill out this form completely to register your trial class!
DANCE: Pre K Ballet, My 1st dance, Dancing to the Hits & more
CREATE: Pre K Art and Family Art Night!
DISCOVER: Preschool Fun and Preschool Plus!
PLEASE FILL OUT 1 FORM PER CHILD!
Parent/Guardian Name *
Your answer
Home Phone *
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Cell Phone/Work Phone *
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Home Address *
Your answer
Email *
Your answer
Emergency Contact Name/Phone Number *
Your answer
Childs Name *
Your answer
Childs Birthdate *
Your answer
Does your child have any medical conditions we need to be aware of: Physical or dietary restrictions/allergies *
If so please explain
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How did you here about this program
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Please check all classes you would like to try!
DANCE: Parent and Child ages 2-3
DANCE: Pre K ages 4-5
CREATE: Pre-K and Family Art for all ages
DISCOVER: Child Development Classes
WAIVER
Generation DCD will endeavor to create as safe an environment as possible for the instruction of my child and myself and will endeavor to offer only sound, safe, and responsible instruction. However, I recognize that Generation DCD is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. Further, I am and will remain responsible for the actions of my child and myself at all times. I hereby agree to abide by the rules and policies of Generation DCD classes as set forth in this contract. I understand that attendance of preschool, youth and adult classes/dance classes, outside performances and flash mobs are not without risk to my child, members of my family, guests who may attend, or to myself. In consideration of, and as inducement to the acceptance of my application for the instruction of these classes, I hereby agree to indemnify and hold harmless Generation DCD, its officers, directors, instructors, agents, employees and/or representatives of any and all claims, or claims by any member of my family, or accompanying guests of mine of injury, expense, costs or damages to myself, my child or any guardian sponsored by me both in class and out of class. In addition, I agree that I will defend and indemnify Generation DCD for any injury, expense, costs or damages to any parent, guardian or children, whether sponsored by me or not, or to third parties arising out of my own actions or the actions of my child. I have read the above-stated provisions, and agree to accept those responsibilities.I ACKNOWLEDGE THAT I HAVE READ THE FOREGOING AND AM COMPLETELY AWARE OF THE POTENTIAL DANGERS INCINCIDENTAL TO MY USE OF THE FACILITIES AND/OR PARTICIPATION IN GENERATION DCD, CLASSES OR PROGRAMS ON OR OFF CAMPUS AND I AM FULLY AWARE OF THE LEGAL CONSEQUENCE OF SIGNING THIS INSTRUMENT.I grant Generation DCD permission to use my photographs and images for the use of publicizing and marketing these classes. I understand that no compensation shall be given for use of these photographs and these images shall become the sole property of Generation DCD. *
Please type your name as acceptance to these terms *
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