2021-2022 Fall/Winter Semester One Registration
Please fill out one form per student. Semester One runs from September 7, 2021-January 31, 2022. See Classes & Registration tab of website for schedule and register by August 1. Please see tuition information below and under the Tuition tab on website. Questions about class placement or want more information? Contact cshepparddanceacademy@gmail.com or call Candi Sheppard 301-996-0680.
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Email *
Student Name *
Student's Preferred Pronouns
Date of Birth *
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DD
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YYYY
Full Mailing Address *
Primary Phone Number *
Parent/Guardian (and student, if applicable) Email Adress(es) *
Parent/Guardian Name(s) *
Parent/Guardian 1 Cell/Business Phone *
Parent/Guardian 2 Cell/Business Phone
Emergency Contact Name, Phone, Email *
Class Selections
Please see the class schedule at https://www.cshepparddanceacademy.com/fall-semester-1-class-schedule and enter each class and its corresponding day/time that the student named above will be attending. Please complete a form for each student.
Class 1 Name *
Class 1 Day/Time *
Class 2 Name
Class 2 Day/Time
Class 3 Name
Class 3 Day/Time
Class 4 Name
Class 4 Day/Time
Class 5 Name
Class 5 Day/Time
Class 6 Name
Class 6 Day/Time
Class 7 Name
Class 7 Day/Time
Class 8 Name
Class 8 Day/Time
Class 9 Name
Class 9 Day/Time
I recognize the risk of accident, illness and injury inherent in any exercise, dance, or gymnastics program. I waive, release, and hold harmless, Candace Sheppard Dance Academy (CSDA), Candace Sheppard and CSDA staff from any liability for injury, damage and liability, of claims arising from my child’s participation in this program. My child is in good physical condition and there is no reason why my child cannot participate in this program. I and my child's other parent or legal guardian (if applicable) consent to the studio requirements related to health and safety. PER DC MANDATORY REQUIREMENTS AS OF JULY 31, 2021, ALL STUDENTS, FAMILY MEMBERS AND OTHERS WHO ENTER CSDA MUST WEAR MASKS REGARDLESS OF VACCINATION STATUS. MASKS MUST FIT SNUGLY TO THE FACE AND FULLY COVER NOSE AND MOUTH AT ALL TIMES WHILE IN THE STUDIO OR WAITING AREA. ANYONE WHO DOES NOT COMPLY WITH THIS REQUIREMENT WILL NOT BE ABLE TO PARTICIPATE AND WILL BE ASKED TO LEAVE THE STUDIO. I and any other parent/guardian will err on the side of caution in keeping my child home when experiencing any potential symptoms of illness. This includes but is not limited to: temperature above 99.5 degrees (without taking acetaminophen or other fever-reducing medicine), cough, chills, shortness of breath or difficulty breathing, chest pain or pressure, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, stomach pain, redness or swelling of lips or tongue, redness or swelling of hands or feet and agree to checking my child's temperature and how they are feeling prior to driving to class. I and any other parent/guardian will ensure my child brings a backup mask and their own water bottle (required) and snack (if needed) to class; and, stays with the teacher in their dance studio space other than to use the bathroom. For our students', faculty members' and CSDA families' health and safety, CSDA is continuing enhanced sanitizing practices: wiping disinfectant on surfaces between groups of dancers and when a new teacher arrives; mandatory hand sanitizer application as students enter; and, no street shoes in dance studios. Parents/guardians of young children who are unable to go up to their cars may wait in the waiting room beginning 5 minutes before their children's class pickup time and promptly take their children upstairs. Thank you.  *
I give permission for CSDA to post pictures or videos including my student (no full names used) for marketing purposes. *
Required
Electronic Signature: Please enter your full name *
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