Session #3 Recreational Class Registration Form

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Please fill out this form to register yourself/your child for the 2021/2022 Dance Season. You will be contacted through e-mail once the form has been received and processed. If you have any questions please contact Impact Dance Co. email impactdancehumboldt@outlook.com If you need any information about any of the classes offered we encourage you to look at the website for a detailed description of each class offered at Impact Dance Company.
impactdancehumboldt.com
If you are registering more than one child - Please fill in a separate form for each child you are registering.

The class you are registering for is a 10 Week Session. After the 10 Week Session is complete you will be given the opportunity to register for the next session. You will need to fill out a form for each session you register for.

Student First & Last Name *

Age of the Student (As of Dec. 31st) *

Birthdate of the student *

YYYY

Parent First & Last Name *

E-mail Address *

Cell Phone Number *

What class(es) are you registering for? *

Recreational Acrodance

Recreational Hip Hop

Recreational Musical Theatre

Required

Do you give permission for Impact Dance Company to use photo's of your child from class, to be used for promotional purposes? *

Yes

Please read and check the box that you understand and agree with Impact Dance Company Studio Contract *

All Statutory Holidays will be observed by the studio, unless otherwise notified. It is the Parents responsibility to keep informed of studio activities via newsletters/emails and website.

Proper dance attire will be expected of each dancer.

Students are to attend class regularly (no refund for missed classes).

IMPACT DANCE CO. will not accept responsibility for any accident, injury, or loss of personal property.

Disruption and disrespect during class and/or break time may result in the student being excluded from the class as well as parents will be notified.

Required

STUDIO Acknowledgement of risk and general release of liability. The following waiver of all claims, release from all liability, assumption of all risks and other terms of this agreement are entered into by me on behalf of the undersigned student (the 'student') with and for the benefit of the Instructors Terralea Armstrong & Kylie Redl-Gosselin, operating as Impact Dance Company, together with their officers, directors, agents, employees, successors, and assigns (collectively 'Instructors'). In consideration of the Instructors allowing the Student to attend the Studio premises, participate in dance lessons, competitions, and all associated activities (collectively the 'Dance Activities') I agree: *

1. The inherent nature of Dance Activities include but is not limited to contact and non-contact poses, tricks, lessons, classes, training, use of facility programs and services provided to the Student by the Instructor(s).

2. I am aware that there are inherent dangers, hazards and Risks ('Risks') associated with the participation in Dance Activities. I am aware that the Risks include but are not limited to injury from physical contact with other students, instructors or equipment, performing a skill incorrectly or potentially dangerous obstacles, conditions on the floor or in the vicinity of Students during Dance Activities. I understand that the Risks are relative to the Students state of fitness or health (physical, mental, and emotional) and to the awareness, care and skill with which with the student conducts hum/herself in Dance Activites.

3. I freely and fully assume and accept all responsibility for all Risks and possibilities of personal injury, loss, or property damage arising from, associated with, or in any way related to the Student's participation in Dance Activities, or their attendance at the Studio premises, including Risks that are both known and unknown.

4. I agree that although the Instructors have taken steps to reduce the Risk and increase the safety of Dance Activities, it is not possible for the Instructors to make Dance Activities completely safe.

5. I accept these Risks and agree to the terms of this waiver even if the Instructors are found to be negligent or in breach of any duty of care or any obligation to the Student in the Student's participation in Dance Activities, or their attendance at the Studio premises.

6. I and my next of kin, executors, administrators, as well as the Students next of kin, executors, and administrators (collectively our 'Legal Representatives') expressly agree: (A) To waive all claims that I, the Student or our Legal Representatives have or may have in the future against the Instructors ; and (B) To release and forever discharge the Instructors from all liability for all personal injury, loss, damage, or property damage arising from, associated with, or related to the Student's participation in Dance Activities due to any cause, including but not limited to negligence on the part of the Instructors (failure to use such care as a reasonable, prudent, and careful person would use under similar circumstances).

7. I, the undersigned, confirm that I have had sufficient time to read and understand each term in this acknowledgment and waiver in its entirety, and have agreed to the terms freely and voluntarily. I understand that by checking the box, I am knowingly and willingly agreeing on behalf of myself, the Student, and our Legal Representatives, to release the Instructors, and their principles, owners, officers, agents, and employees from all liabilities and risks incident to the Student's attendance at the Studio and any associated Dance Activities. I expressly intend that this waiver be binding on myself, the Student, and our Legal Representatives.

Required

Today's Date *

YYYY

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