Industry Xperience Des Moines
September 17-18, 2022

Charlee's Elite School of Dance
16190 SE Laurel Dr, Ste. B
Waukee, IA 50263

charleeseliteschoolofdance@gmail.com
(515) 987-7337

www.industryxperience.com

Schedule will be posted at www.eliteschoolofdance.com/industry-xperience-des-moines when available.
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Email *
Dancer Name *
Dancer DOB *
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Dancer Level *
Check or Cash Only - Payment Must Be Received To Hold Spot.  Checks may be made payable to Charlee's Elite School of Dance.  Payment may be dropped off in the payment box at CESOD.  
Parent Name *
Parent Phone Number *
I acknowledge and consent to allow Industry Xperience/Charlee's Elite School of Dance to use: photos and/or videos of my child/myself in publications (such as flyers/brochures), advertisements (such as newspapers or online ads), our studio’s website, or on social media sites (such as the studio’s Facebook or Instagram account). I understand that in some cases, my child and/or my name may be used. I further understand no financial compensation will be for use of these photos/videos. *
I agree that we will comply with Industry Xperience/CESOD’s rules, policies and procedures as they exist. I understand that dance instruction, performance and related activities involve some risk of injury or harm, and I assume all liability (whether for injuries or otherwise) arising out of my child’s participation in such activities. I agree to indemnity and to hold Industry Xperience/CESOD and its owners and employees harmless from and against any and all liability, damages, costs, claims and expenses incurred by any of them in connection with my child’s participation in any Indusry Xperience/CESOD activity. If Industry Xperience/CESOD determines that an injury suffered by my child requires medical attention, I understand that Industry Xperience/CESOD will make every reasonable effort to contact me. I herby give permission for emergency medical treatment to be given to my child by providers chosen by Industry Xperience/CESOD. By signing below, I further bind myself, my child and our respective heirs, executors, administrators and assigns. *
A copy of your responses will be emailed to the address you provided.
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