Thomas Armour Youth Ballet's Virtual Summer 2020
fill out and submit the form below to register for our South Miami location's virtual summer sessions. If you have any questions please text (305)667-5543 or email Info@taballet.org
Email address *
Parent's Name *
Your answer
Child's First Name *
Your answer
Child's Last Name
Your answer
Child's Middle Name
Your answer
Summer Classes Session I
Summer Classes Session II
Child's date of birth *
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Child's gender *
Miami-Dade County public school ID #
Your answer
No MDCPS ID #
Child's current school *
Your answer
Is your child proficient in English? *
Other languages spoken in your home? *
Required
Street address *
Your answer
City and zip code *
Your answer
Child's ethnicity *
Child's race (select only one) *
Required
Child's current grade *
Your answer
Does child have health insurance? (ex., private insurance, KidCare, Medicaid. If not, we may be able to help you find affordable coverage – call 211 or visitwww.thechildrenstrust.org/parents/health-connect/insurance.) *
Do you have medicaid? *
Child's primary caregiver's full name *
Your answer
Primary caregiver's email address *
Your answer
Primary phone number *
Your answer
Is this a cell phone number? (Please note that The Children’s Trust may contact you via postal mail, email and/or text to ask about your satisfaction with these services, and to make you aware of other Trust-funded programs, initiatives and events you may be interested in.) *
We want to get to know your child better so that we can provide the best possible experience in our programs. Please tell us more about your child…What are the main ways in which your child communicates? (Mark all that apply)
What, if any, help does your child receive at this time? (Mark all that apply) *
Required
What conditions does your child have that are expected to last for a year or more? (Mark all that apply) *
Required
If you marked “None of the above” on the previous question, please skip the next two questions and sign below. If you marked any other answer to the question above, please answer the remaining questions and sign below.
Do any of the conditions marked above make it harder for your child to do things that other children of the same age can do? *
To support your child’s successful participation in this program, in what areas might s/he need extra assistance?
Please tell us anything else you think is important for us to know about your child. *
Your answer
If you are interested in other services funded by The Children’s Trust, please call 211 or visit www.thechildrenstrust.org. For special needs resources for your child, visitwww.advocacynetwork.org or www.thechildrenstrust.org/cwd
I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation
purposes. The Children’s Trust provides funding for the program.
I give my permission for this information to be submitted to The Children's Trust for program quality and evaluation purposes. The Children’s Trust provides funding for the program. *
I confirm that the information above is true and agree to sign this registration form electronically. *
Required
Signature *
Your answer
THOMAS ARMOUR YOUTH BALLET, INC. Release and Waiver of LiabilityIf participant is under 18 years of age
The undersigned is the parent or legal guardian of the child under the age of 18 named below (the “Participant”), who wishes to participate in the Thomas Armour Youth Ballet, Inc. dance program (the “Program”). In consideration of the Program allowing my child to participate, I hereby agree to indemnify Thomas Armour Youth Ballet, Inc., directors, officers, agents and employees and its owners, managers, promoters, lessees of premises used to conduct the Program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the Program facility or events held at such facility and each of them, their directors, officers, agents, and employees (the “Releasees”) and to hold them harmless from any claim or demand on account of injury to or damage suffered by my child as a result of his or her participation, whether on the Program premises or elsewhere. I acknowledge it is my responsibility to deliver my child(ren) to the Program and to pick up my child(ren) promptly upon the scheduled conclusion of dance class(es). If competing or performing in an offsite event or venue, I assume responsibility for transportation of myself and/or my child(ren) to and from those events and/or venues. *
Your answer
The Program operates a youth dance program and the Participant wishes to participate in the Program. In consideration of being permitted to participate in any way in the Program indicated above and/or being permitted to enter for any purpose in any restricted area, I/WE agree as follows. List name of the participant *
Your answer
Address *
Your answer
1. I/WE fully understand and acknowledge that:(a) There are risks and dangers associated with participation in Program events and activities which could result in bodily injury partial and/or total disability, paralysis, and death. (b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. (c) These risks and dangers may be caused by the action, inaction or negligence of the Participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named above. (d) There may be other risks not known to us or are not reasonably foreseeable at his time.2. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis, or death, however, caused and whether caused in whole or in part by the negligence of the Releasees named above.3. I/WE agree to take appropriate precautions for my own safety and that of others when participating in the Program and further agree that, before participating I will inspect the facilities and equipment to be used and will if I believe anything is unsafe, immediately advise a staff member of that unsafe condition(s) and will refuse to participate.4. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Thomas Armour Youth Ballet, Inc., including its Releasees from any and all claims, demands, damages, actions, causes of action of any kind or nature whatsoever which may arise in the future any injury, including but not limited to the death of the participant or damage to the property, arising out of or relating to the event(s) caused or alleged to be caused in whole or in part by the negligence of the Program or otherwise.5. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.6. On behalf of the Participant, the undersigned executes this Waiver and Release. If despite this release, the Participant makes a claim against any of the releases, the undersigned will reimburse the Releasees for any money which they have paid to the Participant, or on his behalf, and hold them harmless. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Please electronically sign below *
Your answer
Date *
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