Registration for Summer Break Dance Program at North Tampa Christian Academy
This is registration for Dance Program held during Summer Break at North Tampa Christian Academy and North Tampa Christian Explorers. This Dance Program is under the direction of The Creative Movement Company. After completing this form Ms. Jennifer Rosoff (Director of Program) will contact you with payment information. Payment is due prior to classes beginning. Discounts available for multiple children and staff children. For additional information please email Jennifer@CreativeMovementCo.com or call 727-265-1229.
Email address *
Child Name *
Your answer
Child Age, Grade, Teacher Name *
Your answer
Which Summer Camp(s) are you enrolling your child in? *
Required
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Does your child have any mobility or sensitivity concerns that you would like to share with us? (If none, please write N/A) *
Your answer
Does your child have any allergies and/or health related concerns? (If none, please write N/A) *
Your answer
MEDIA RELEASE: The Creative Movement Company (TCMC) strives to celebrate the accomplishments of its students and promote our Dance Program by sharing information with the public. To do this, TCMC may choose to publish photographs and/or videos of students. By checking the box below, you are granting TCMC and North Tampa Christian Academy permission to use your child's name, voice, picture, and likeness in connection with any and all publications, promotional materials, websites, commercial products, social media and all other forms of media.
I Agree to Media Release *
Required
MEDICAL / LIABILITY RELEASE: Your child's safety is our biggest priority. It is our policy to notify a parent when a child needs medical attention; however, in the event of an emergency, we might need to seek immediate help. In that case we would notify you and/or your emergency contact person as soon as possible. By checking the box below, you give your permission for any and all medical attention to be administered to your child in the event of accident, injury, sickness, etc., under the direction of the staff of The Creative Movement Company (TCMC) until such time as you can be contacted. You also agree to assume responsibility for the payment of any such treatment (including ambulance service and hospital/ physician bills) and to release the staff of TCMC from any liability related to the emergency treatment. By registering your child for our dance program you are agreeing to not hold The Creative Movement Company and their respective members, independent contractors, volunteers, teaching locations and event locations responsible for or bring against any and all claims of damages or causes of action, including but not limited to death, personal injury or loss or damage to property, of which the student may have or which may accrue hereinafter accrue in connection with his/her participation with this program.
I Agree to Medical / Liability Release *
Required
How did you learn about this Dance Program? *
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