Emerge Dance Academy Student Registration Form for the 2020-2021 Season
Dancer's First and Last Name *
Dancer's Date of Birth: *
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Registering multiple dancers? Enter dancers names and their date of birth below:
Parent/Guardian first and last name: *
Contact email *
Contact Phone Number *
Full Address *
Emergency Contact Info: *
Please use the space below to inform us about any information that would help us with create a safer and more inclusive environment for your dancer. This includes medical concerns, allergies, special pronouns, learning difficulties etc.
Classes for registration of the 2020-2021 season: *
Required
COVID-19 Release - I understand and agree that even with social distancing and sanitization protocols, there is a possibility of contracting COVID-19 (coronavirus disease) while attending Emerge Dance Academy. I voluntarily agree, therefore, to assume all risks and responsibility of contracting COVID-19 which me or my child may contract during any of Emerge Dance Academy Inc classes, rehearsals, performances, or activities. I also exempt and release, Emerge Dance Academy Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with COVID-19. I agree and give full consent to active symptom screenings for my child which may include a temperature check. I understand and agree that I will not send my child to Emerge Dance Academy Inc if they are sick even if symptoms resemble a mild cold. Symptoms to look for include fever, cough, shortness of breath, sore throat, runny nose, nasal congestion, headache, and a general feeling of being unwell. I understand and have made my child aware that they are to inform an Emerge Dance Academy Inc staff member immediately should any of the above-mentioned symptoms develop while at Emerge Dance Academy Inc. Should this occur I understand my child will be isolated until they are picked up by a parent or guardian. I understand it is my responsibility to ensure my child is picked up immediately when notified. I understand and agree that CMOH Order 05-2020 legally obligates individuals who have a fever, cough, shortness of breath, sore throat, runny nose (that is not related to a pre-existing illness or health condition) to be in isolation for 10 days from the start of symptoms or until symptoms resolve, whichever takes longer. I have alerted Emerge Dance Academy Inc of any and all medical conditions and allergies of my child. I understand it is especially important to alert Emerge Dance Academy Inc of any health conditions my child has which may causes similar symptoms of COVID-19. These health conditions and symptoms include but are not limited to a cough and/or shortness of breath due to asthma or exercise induced asthma, and/or a sore throat, runny nose and/or nasal congestion due to severe seasonal allergies. If I am signing this waiver for my child or children, I certify that I am the parent or legal guardian and have the right to waive these rights. *
Required
General Release- I understand and agree that in participating in any dance class, rehearsal, audition or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Emerge Dance Academy Inc classes, rehearsals, performances, or activities. I also exempt and release, Emerge Dance Academy Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Emerge Dance Academy Inc. I have alerted Emerge Dance Academy Inc of any and all medical conditions and allergies on my registration form. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. *
Permission is granted to Emerge Dance Academy Inc to use photographs and video of students for promotional and publicity purposes. *
Termination of this agreement will require written notification to be received at least 30 days prior to the termination date. All lesson fees prior to notice given are non refundable. I understand that due to potential of cancelled classes due to the COVID-19 pandemic- that once my monthly fee is processed on the first of the month, that monthly fee is non-refundable (the next month's fees will not be charged in the case that Emerge Dance Academy has to temporarily close due to Covid-19) *
I AGREE TO ALL OF THE ABOVE *enter your full name below *
Preferred method of payment *
Questions or Concerns?
Registration Fee amount:
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