FSDance 2021 Summer Registration
One form per child.
Email *
STUDENT'S NAME *
PARENTS' NAMES *
CUSTODIAL CARE BELONGS TO *
MAILING ADDRESS including Zip *
PHONE (multiple if needed) *
DANCER'S AGE *
DANCER'S BIRTHDATE *
MM
/
DD
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YYYY
DANCER'S upcoming GRADE & SCHOOL *
YEARS OF DANCE INCLUDING LOCATIONS *
EMERGENCY CONTACT - someone that could be reached in case you are not available. Please include name, phone and relationship *
ALLERGIES OR MEDICAL CONDITIONS we should be made aware of *
HOW DID YOU HEAR ABOUT US? *
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, Sue Savage is authorized to act on my behalf. Furthermore, I agree to hold harmless Farmington School of Dance and all of their employees and agents in the event of an injury occurring to my child during any activities associated with the Farmington School of Dance. 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. I also allow all pictures and film taken of my minor child to be used for publicity purposes for the Farmington School of Dance. I hereby indemnify and hold harmless against any and all claims of damages arising out of taking or use of pictures or videos of my minor child. I agree that my child and I will abide by the standards set by this studio in the parent handbook. I understand my physical signature will be needed in person. *
Covid addendum
I agree to hold harmless Farmington School of Dance and all of their employees and agents in the event of an illness occurring to or contracted by my child. I recognize that coming into contact with an undiagnosed illness is possible. I certify that my child is, to the best of my knowledge, medically able to participate in this activity. I assume full financial responsibility for medical expenses arising out of such illness.*I understand that if anyone in my family or anyone we’ve been around has been ill or has any symptoms, I will not bring my child to class.*I agree to allowing my child to use hand sanitizer in class or will let my child’s teacher know if they have an allergy and are not able to use it.*I understand that this is a physical activity & because it involves children, I understand that the employees of Farmington School of Dance will do their best to keep dancers at a safe distance from each other but cannot guarantee that they can keep dancers 6 feet away from each other the entire time they are in the building.*I understand that the lobby is closed to parents and that dancers will be dropped off at the door. I also will inform anyone else who brings my child to class of these rules.
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Our summer session is $75 for 6 lessons on M, W, Th starting July 26th. I understand that this fee is due at summer registration on Monday July 19th along with ordering dance shoes.
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A copy of your responses will be emailed to the address you provided.
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