Challenger Sports Spring Dance Program 2019
Dancer's First Name *
Your answer
Dancer's Last Name *
Your answer
Male or Female *
Date of Birth *
Your answer
Age. Must be age 8 and up. *
Your answer
Grade *
Your answer
School *
Your answer
Parent and/or Guardian Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Telephone Number *
Your answer
Cell Phone Number *
Your answer
E-Mail Address *
Your answer
Please describe and name the player's special needs or diagnosis so that we can do our best to accommodate him/her. Include any medical conditions that we should be away of. Please indicate if they need assistive devices such as...wheelchair, braces, walker, crutches...or any amount of assistance. *
Your answer
Cost for Dance Program session is $20. Please make check payable to UT Challenger Sports and mail to 4 Crestview Dr, Seaville, NJ 08230 by 03/15/2019. *
Family and friends tickets to the recital will be an additional cost. Also potential cost for recital outfit like a bright t-shirt and black pants. Any changes will be discussed as a group at dance practice.
Required
Dance session schedule is Fridays 6:30-7:30 3/15 - 3/29 - 4/05 - 4/19 - 5/10 - 5/31 - 6/07 - 6/14. Dates are subject to change if needed. 6/13 will be dance recital practice at MRHS. Time TBD. Recital will be either Friday 6/14 or Saturday 6/15. *
Dates and times are subject to change
Required
I/We give permission for my son/daughter to participate in the Upper Township Challenger Sports Program. If my son/daughter is over the age of 18, I represent that I have legal authority to sign on their behalf. I/We agree to return equipment issued to my child in good condition as when received, except for normal wear and tear. I/We assume all risk of injury due to participation in this sport and release the Township of Upper and Upper Township Challenger Sports Program for any liability in this regard. I/We give permission to Upper Township Challenger Sports and Township of Upper to display my son’s/daughter’s photo. *
Required
In case of medical emergency, I understand that when medically feasible, an effort will be made to contact a parent/guardian, but in the event one is not reached or it is not medically feasible to contact one, I hereby give permission for my child to be treated. In the event consent is needed for medical care on a non-emergency basis and I cannot be reached, Starstruck Dance Academy and all of its staff members are authorized to act on my behalf. Furthermore, I agree to hold harmless Starstruck Dance Academy and all of their employees and agents in the event of an injury occurring to my child during any activities associated with the Starstruck Dance Academy. I recognize that participating in this activity has a certain amount of risk and that an injury is always possible. I certify that my child is, to the best of my knowledge, physically able to participate in this activity. I assume full financial responsibility for medical expenses arising out of such injury. *
Required
A parent or Guardian must be present at dance session/recital, *
Required
The dancers will be wearing the dance recital t-shirt as their costume. Please select shirt size. Cost of the shirt TBD. *
Please list first and last name for how the dancer's name will be listed on the recital t-shirt. *
Artwork for this year's recital on the front and full cast list of dancers names on the back
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