North Star Ballet Registration Form
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I have read and understand North Star Ballet's COVID-19 Protocols (link: nsbfairbanks.org/covid-19). *
Guardians / Students are required to inform North Star Ballet if they suspect their child /they has/have COVID-19, or have tested positive for the virus. Symptoms include but are not limited to: 100+ degree fever, difficulty breathing, coughing, headaches, loss of sense of smell and taste, nausea. By INITIALING below you agree to notify North Star Ballet if you suspect your child/you might have COVID-19. Your information will be kept confidential. *
Student Name (First & Last) *
Student Birth Date *
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Grade Level (if applicable)
Student Gender *
Student Prounouns
Please select the class(es) you wish to register for. If you don't know, please select "unsure" and we will reach out to you to figure out the best fit. *
Required
Guardian Name, First & Last ( Adult students please write "Self") *
Phone Number *
Guardian/ Adult Student Email *
Minor student's email if applicable
Emergency Contact Name (must be different than Guardian 1) *
Emergency Contact Phone Number *
Mailing Address (Please include City, State, & Zip) *
Have you/ your child ever been treated by a physician for: *
Required
Is there anything else (including cognitive or social/emotional considerations) that we should know about in order to help you / your child succeed? *
Do you / your child have any allergies including food allergies? *
What prior dance experience do you / your child have, if any? *
How did you hear about North Star Ballet?
ASSUMPTION OF RISK AND RELEASE OF LIABILITY North Star Dance Foundation is a non-profit, non-commercial enterprise that has taken reasonable precautions to provide a safe exercise environment. However, as with any physical activity, injury is a possibility and a concern. Therefore, the parents or legal guardians of a minor participant must understand and agree that they assume the risk of injury when they, their son, daughter, or minor in their care participate in North Star Dance Foundation activities. The participant's parents or guardians specifically agree to release the North Star Dance Foundation for any liability arising from any injury or loss to the participant. Furthermore, participant and the participant's parents or guardians agree to hold the North Star Dance Foundation harmless from any claims arising from the participant's participation in North Star Dance Foundation activities, including possible communicable disease such as COVID-19. MEDICAL CONSENT I hereby give my consent, in the event of injury or illness, for emergency medical treatment, hospitalization, or other medical treatment as may be necessary for the welfare of the above-named participant, by a physician, nurse, certified athletic trainer, physical therapist, and/or other medical staff under the supervision of a physician and/or hospital during all periods of time in which the participant is engaged in an activity sponsored by the North Star Dance Foundation. Further, I hereby waive, on behalf of myself and the above participant, any liability of the North Star Dance Foundation, their Board of Directors, agents or employees arising out of the participant's illness, injury or medical treatment thereof. RELEASE AND AUTHORIZATION FOR USE OF VIDEO AND STILL PHOTOGRAPHS The North Star Dance Foundation, North Star Ballet School, and North Star Ballet are authorized to use any video recordings still photographs, other likenesses, or reproductions of the participant made during performances, rehearsals, Dance Class or Dance Camp. I understand that the recordings, photographs, and/or other likenesses or reproductions may be used to promote and advertise the activities of the North Star Dance Foundation. I understand that these materials may be used for entertainment, informational, instructional, or archival purposes. I further understand that these materials may be made available for sale to the public. I understand that the participant will receive no compensation and that the participant has no claim for compensation for participation in any recording, photographing, or the creation of any other likeness or reproduction of the participant. I understand that if I do not want images of my dependent to be used, I will indicate this in writing. AWARENESS, VERIFICATION, PERMISSION, AND RELEASE By signing this document, the participant or parents or legal guardians of the minor age participant, certify that they have read this document and that they understand it, that they have inspected or have had the opportunity to inspect the premises, that they have had an opportunity to inquire regarding the qualifications and background of the instructors and other agents of the North Star Dance Foundation, and that they have had all questions and concerns answered to their satisfaction. In consideration of the acceptance and participation of the applicant in such program, the undersigned applicant and his or her parents or guardians, to the full extent permitted by law, release and agree to save, hold harmless and indemnify all members, officers, directors, committee members and employees of the North Star Dance Foundation from all liability for any loss, property damage, personal injury or death, including any such liability which may arise out of the negligence of any such persons or entities, which may be suffered or claimed by such applicant, parent or guardian during, or as a result of the participation by the applicant. *
Required
AGREEMENTS, CERTIFICATIONS AND SIGNATURES. Please type your name below, indicating you have read and understand the terms and conditions of this agreement, and hereby agree to abide by them. *
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