Registration
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Event:
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End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Father
Guardian
Mother
Other
Parent
Home Phone:
*
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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Zip:
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Emergency Contact Info
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE and specify if its a preference of life threatening)):
Allergies (Leave blank if NONE and specify if its a preference of life threatening):
Medications (Leave blank if NONE and specify if its a preference of life threatening):
Primary Doctor:
Promotional Code:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE and specify if its a preference of life threatening)):
Allergies (Leave blank if NONE and specify if its a preference of life threatening):
Medications (Leave blank if NONE and specify if its a preference of life threatening):
Primary Doctor:
Promotional Code:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE and specify if its a preference of life threatening)):
Allergies (Leave blank if NONE and specify if its a preference of life threatening):
Medications (Leave blank if NONE and specify if its a preference of life threatening):
Primary Doctor:
Promotional Code:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE and specify if its a preference of life threatening)):
Allergies (Leave blank if NONE and specify if its a preference of life threatening):
Medications (Leave blank if NONE and specify if its a preference of life threatening):
Primary Doctor:
Promotional Code:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE and specify if its a preference of life threatening)):
Allergies (Leave blank if NONE and specify if its a preference of life threatening):
Medications (Leave blank if NONE and specify if its a preference of life threatening):
Primary Doctor:
Promotional Code:
Additional Information:
Medical Release
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I have read and agreed to the below medical release.
I hereby give my permission to Leighton Dance Project (“LDP” for this agreement), its owners, operators, officers, directors, agents, supervisors, instructors, teachers, administrators, and agents to seek and give appropriate medical attention to Students in the event of an accident, injury, and/or illness. In case of an emergency, my child may be treated by a qualified physician. I understand that LDP does not assume responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. Student or Parent understands that no medical benefits or services will be provided during any LDP programs and that Student and/or Student’s insurance shall be solely liable to pay for any medical expenses incurred on Student’s behalf.
PHYSICAL CONDITION
I, the Student, Parent, or Authorized Agent, represent and warrant to LDP that the Student has no physical or psychological problems that would prohibit the Student from participating in the activities at LDP. The parent has consulted a personal physician or has taken whatever steps deemed necessary to determine that the Student’s status is of good health with no conditions that might limit participation in activities offered by LDP, including but not limited to dance, acro, gymnastics, tumbling, performing arts, acting, singing, fitness, yoga, and pilates.
RISK OF INJURY
I, the Student, Parent, or Authorized Agent, recognize and acknowledge that activities offered by LDP (including but not limited to dance, acro, gymnastics, tumbling, performing arts, acting, singing, fitness, yoga, and pilates), whether in-person, outdoors or via online webcast, are strenuous exercise and vigorous physical activities and that such activities have an inherent risk of physical injury. That practice is dangerous and involves certain risks including, but not limited to (a) loss of, or damage to, personal property and (b) bodily injury, such as sprains or strains, impact injuries, and blisters or fatality. As a voluntary participant, Student understands and accepts all of these and other risks associated with participation at LDP, no matter how remote or unlikely. Additionally, with the use of outdoor activities, I recognize and acknowledge that there is an inherent risk of injury with regard to the proximity of street traffic, passersby, parking lot activities, and exposure to environmental elements.
I've read the above and agree.
Environment Policy
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I have read and agreed to the below environment policy.
CREATIVE LEARNING ENVIRONMENT
LDP is committed to providing a creative learning environment. As such, LDP does not tolerate any of the following and any Student, or his/her Parent, family friend, or agent, engaging in any of the following, as determined in the sole discretion of LDP, will result in Student’s dismissal from the current program, without refund, and the account will be put On Hold: (i) physical aggression towards any other person; (ii) refusal to participate; (iii) inability to pay attention or focus; (iv) lack of preparation; (v) disruptive behavior; (vi) verbally abusive or threatening behavior (physical or emotional) towards any other person; (vii) inability to stay in rehearsal room or performance venue without Parent or agent; (viii) causes harm, or threatens to cause harm, to self, others or property of LDP or another; (ix) intentionally exposes a sick or contagious Student or self to others; (x) throws objects; (xi) takes or hides others belongings; (xii) violence; (xiii) vandalism; (xiv) sexual misconduct; or (xv) any other action or inaction that violates the policies and behavior as contemplated by and outlined in this agreement determined in the sole discretion of LDP. Furthermore, the possession, use, and/or sale of cigarettes, alcohol, cannabis, or illegal drugs at the studio, LDP events, performance, and/or competition venues will result in immediate dismissal without refund.
ANTI-BULLYING POLICY
LDP recognizes the harmful effects of bullying. As such, LDP does not tolerate bullying of any kind by either a Student or a Student's Parent, family members, friends, or agent, especially bullying directed towards another member of the LDP community, be it threatening, physically intimidating, or saying or writing hateful or mean-spirited words anywhere, at any time, associated with an LDP event or performance, either in person or online, or by any other way of communication, be it writing or otherwise, made directly or indirectly to another Student.
PROPERTY DAMAGE
I agree that I am responsible and agree to timely reimburse LDP, for any damage to any LDP property caused by Student, Parent, family member, or agent. LDP property includes costumes and any property for which LDP is responsible, whether or not owned by LDP, such as venue property and rented props. Further, I agree that LDP may put my account On Hold at any time if the Student, Parent, family member, friend, or agent refuses to reimburse LDP for property damage.
I've read the above and agree.
Release of Liability
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I have read and agreed to the below release of liability.
RIGHT TO USE LIKENESS
I Authorize LDP to allow Students' images in photos and videos for print publication/advertising and online on web pages and all social media, including live streaming, for promotional and educational purposes. If you would like for LDP to not use your child in social media or marketing materials please fill out the form linked below. This form is NOT GUARANTEED but a way for us to be notified, and we will be mindful of the request.
Request for Social Media/Marketing Materials Dismissal
Social Media Release of Liability
I understand that LDP may use such photographs or videos with or without associating names thereto.
I further waive any claim for compensation of any kind for LDP's use or publication of photographs or videos of my minor child.
I hereby fully and forever discharge and release LDP from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of names, likeness, or image) arising out of the use or publication of photographs or video of my minor child by LDP, and covenant and agree not to sue or otherwise initiate legal proceedings against LDP for such use or publication on behalf of my minor child. All grants of permission and consent and all covenants, agreements, and understandings contained herein are irrevocable.
WAIVER & RELEASE
As a material inducement for LDP to permit Student to participate in any LDP activity, whether in-person, outdoors or via online webcast (including but not limited to: dance, acro, gymnastics, tumbling, performing arts, acting, singing, fitness, yoga and pilates), to use LDP facilities or LDP Equipment, Student (or Parent/Authorized Agent), hereby, on behalf of yourself, your heirs, executors and assigns, fully, forever and irrevocably waive, release and hold LDP harmless from any and all claims (including, to the extent permitted by applicable law, claims alleging negligence on behalf of LDP, injuries, death, damage or loss (including legal fees), present or future, foreseen or unforeseen, anticipated or unanticipated (collectively “Claims”), that you, Student, Student’s family and/or Student’s guests have (or that accrue to the same) against LDP and generally release and discharge LDP, their employees, agents, representatives, elected officials, contractors, subcontractors, successors, heirs, assigns, lessors, affiliates, volunteers and legal representatives from any and all claims, including but not limited to those involving (i) participating in any supervised or unsupervised dance, acro, gymnastics, tumbling, performing arts, acting, singing, fitness, yoga, pilates and other fitness activities, (ii) use of any fitness training equipment, props, sets, including LDP Equipments, (iii) any loss or theft of personal property, and (iv) accidental injuries, such as “slip and fall” injuries on or outside of LDP premisses, licensed areas, and/or venues and Student (or Parent/Authorized Agent), hereby promise never to assert or assist any other party in asserting, any claims or causes of action against LDP in any matter that in any way relates to and Claims.
LIMITATION OF LIABILITY
The parties to this agreement acknowledge and agree that LDP and none of its employees, Kelli Leighton, or any of its agents are personally liable for any litigation or disputes arising hereunder, whether direct or indirect and of any nature whatsoever. Any liability of LDP, Kelli Leighton, or its agents alleged by Student or Parent shall be limited to three (3) months of Student’s payments to LDP for the activity registered by Parent/Student during the period triggering liability (“Liability Period”). If a Student registers for multiple activities during the Liability Period, the LDP’s liability shall be limited to three (3) months of payments for only one activity, whatever is the lowest. Student and Parent agree to look only to LDP’s/Kelli Leighton’s/agent’s role under this agreement and not to LDP/Kelli Leighton/agent personally, and no other property or assets of LDP or Kelli Leighton or agent shall be subject to levy, execution or other enforcement procedure for the satisfaction of Student’s/Parent’s claims under or with respect to this agreement.
SEVERABILITY
Student expressly agrees that this agreement is governed by the State of California and is intended to be as broad and inclusive as permitted by California law and that in the event any portion of this agreement is determined to be invalid, illegal, or unenforceable, the validity, legality, and enforceability of the balance of the agreement shall not be affected or impaired in any way and shall continue in full legal force and effect.
VENUE
The student agrees that if, in spite of this contract, legal action is brought regarding a claim, it must be brought in the Superior Court of California, County of Sacramento, and further agrees that the substantive laws of the State of California shall apply in any action brought.
ATTORNEY’S FEES
Student acknowledges that this agreement is a contract and agrees that in the event of a dispute, claim, action, proceeding, pre-litigation matters, or lawsuit arising from or in connection with the execution, noon-performance, or breach of any obligation of this agreement, Student shall pay all attorney’s fees and costs, including, without limitation, expert witness fees and costs, incurred by LDP.
INCORPORATION
The BAYPAC Agreement for Parents and Students and LDP Participation Policies are fully incorporated herein by reference.
ENTIRE AGREEMENT
This agreement is the entire agreement between the parties with respect to the subject matter hereof and supersedes all statements, negotiations, agreements, and understandings not herein included or referenced. This agreement may only be amended by a written document signed by all parties.
I've read the above and agree.
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