The Magic of Broadway - Backstage Registration
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Student Name *
Student Age
Phone Number *
Email Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Any allergies/medical information we should be aware of? *
Photo/Video Release - I acknowledge and consent to allow The Conservatory of Extraordinary Dance to use photos and/or videos of my child/myself in publications (such as flyers or brochures), advertisements (such as newspapers or online ads), the studio’s website, or on social media sites (such as the studio’s Facebook or Instagram accounts). I understand that my child and/or my name may or may not be used. I further understand that there will be no financial compensation for use of these photos/videos. *
Liability Release - By signing my name below (parent/guardian required for youth under 18 years of age), I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I hereby release and hold harmless The Conservatory of Extraordinary Dance, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of The Conservatory of Extraordinary Dance, its owners, and operators, or in route to or from any of said premises. *
I understand that lunch is NOT provided by The Conservatory of Extraordinary Dance, and that I must provide lunch for myself/my child. Limited kitchen facilities are available including a refrigerator, microwave, stovetop, and oven for storage/preparation. *
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