RED Fall Registration 2020
Email address *
Student Name *
Date of Birth *
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Age *
Grade (2020-2021) *
Street Address *
City *
Zipcode *
Mother's Name *
Mother's Cell *
Father's Name *
Father's Cell *
Emergency Contact (Other Than Parent) *
Emergency Contact Relationship to Student *
Emergency Contact Number *
PLEASE LIST ANY ALLERGIES, PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS THE STUDENT MAY HAVE. *
Dancer T-Shirt Size *
How did you hear about us? *
HOW MANY YEARS EXPERIENCE DOES YOUR DANCER HAVE? EXPLAIN. *
WHAT DAYS OF THE WEEK ARE YOU AVAILABLE AND TIMES PREFERED FOR APPOINTMENT? *
WHAT STYLES OF DANCE ARE YOU INTERESTED IN? (MARK ALL THAT APPLY) *
Required
WAIVER AND RELEASE FORM INFORMATION
I attest that the above stated physical, mental, and emotional limitations of the student are accurate. I understand that dance and tumbling, sometimes involves extraordinary use of motion. When practicing the art of dance, there are some possibilities for but not limited to the injury of muscle or bones. In consideration for using/ allowing my child/ self, to utilize the facility and staff of Revolution Elite Dance; I hereby forever release the owners, staff, directors, coaches, and all other employees from liability for any injuries suffered by myself or any student in connection with the uses of this facility at 5614 126th Street. I acknowledge that participation is entirely by choice and I am under no compulsion by Revolution Elite Dance to participate in the programs, nor am I being paid to do so. The interest of myself and my child is solely to participate in the art and his/her self-improvement, and I am willing to accept the inherent risk in this pursuit.
Please read statements below and the checkbox to indicate you agree to all Waiver and Release Information: *
Required
This acknowledgment of risk and waiver having been read thoroughly and understood completely is signed voluntarily as to its intents and contents.
Permission to Administer Emergency Treatment
In my absence, and as a parent or legal guardian of ________________________, I hereby grant my permission, in the event of sickness or injury, to have the necessary treatment administered to my child by a trained professional. In addition, I also grant my permission to have my child transported to the hospital, doctor’s office, or an emergency clinic in the event of such injuries or illness. *
Signature of Parent/ Guardian *
COVID-19 AGREEMENT/INFORMATION
I agree to keep my dancer home if she/he or anyone in my family is coughing, has a temperature over 100, or other Covid-19 symptoms. *
I understand and agree that these procedures will change and evolve over time and that I will follow any new standards required by the State of Texas and Revolution Elite Dance. *
I understand that the Revolution Elite Dance Staff and everyone at the studio will make a strong effort to maintain social distancing but that there will be times when incidental contact and less than prescribed physical distancing will occur. I am aware and agree that spotting is an essential part of training my dancer in order to keep her/him safe and to prevent injury. I will allow my child to be spotted when spotting is necessary. I further understand that I am voluntarily allowing my child to participate in programs and activities offered by Revolution Elite Dance, knowing that it is impossible to keep her/him, myself, or anyone else who enters the gym completely safe from exposure to the Covid-19 virus. I accept that risk.
Clear selection
PICK-UP/DROP-OFF PROCEDURES: I understand that I must follow rules set forth by Revolution Elite Dance to ensure that students enter/exit building in safest manner possible. I will agree to stay informed when information is sent out about pick-up/drop-off information.
By signing below I am agreeing to all the above statements. I authorize Revolution Elite Dance to use my electronic signature. *
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