Balance Dance Registration
One form per dancer
Dancer's Name
Your answer
Dancer's Age
Your answer
Class Preference
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Grade
Parent Name
Your answer
Home Street
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Home City
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Home Zip
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Email address
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Mobile phone number
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Is it ok to text
Emergency Contact Name
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Emergency Contact Number
Your answer
Release and Indemnification Agreement
I understand and acknowledge that dance instruction and performances offered by Balance Dance Studio involves many RISKS, DANGERS and HAZARDS. I also understand and acknowledge that I, or the above-named student(s), may encounter risks, dangers and hazards at any time or place during the course of the dance instruction, classes and performances offered by Balance Dance Studio, and that serious INJURY may result. I FREELY ASSUME ANY AND ALL RISKS OF INJURY INVOLVED IN CONNECTION WITH DANCE INSTRUCTIONS, CLASSES AND PERFORMANCES OFFERED BY BALANCE DANCE STUDIO.I hereby unconditionally RELEASE FROM ALL LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS, Balance Dance Studio, its owners, representatives, agents, contractors, officers, directors and employees (collectively “Balance Dance Studio”) of and from any claims for damage, injury to myself, the above named student(s), or to any person or property, in any way connected with my participation or the participation of the above named student(s) in Balance Dance Studio instruction, classes or programs. I agree to WAIVE ALL CLAIMS that I or the above named student(s) may now have or which may arise against Balance Dance Studio as a result of such instruction, classes or programs.I have carefully read and I understand this agreement and all of its terms. I understand that this is a RELEASE OF LIABILITY which will legally PREVENT me or any other person from recovering in any lawsuit, or in connection with any legal claim, for damages in the event of any injury to me or the injury to, the above-named student(s). I nevertheless enter into this agreement freely and voluntarily and agree that it is binding upon me, my heirs, assigns and legal representatives.If I am signing this document on behalf of a minor child, I represent that I have legal authority to make all of the waivers and releases contained herein on behalf of such child and I hereby agree to INDEMNIFY and HOLD BALANCE DANCE STUDIO HARMLESS FROM ALL LIABILITY INCURRED AS A RESULT OF ANY LACK OF AUTHORITY ON MY PART TO MAKE SUCH WAIVERS AND RELEASES.
Required
Payment Information - Please Pay Registration Fee to hold your spot. ($60 per family new students/$50 per family returning students)
Health Concerns (if any)
Your answer
Referred by?
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Comments
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