Registration

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Welcome to Adult Hip Hop! If you have previously attended a pop-up class or are an existing Dance Arts student and have a portal account, please click the link above. If you are NEW to Dance Arts, please complete the form below. Once you complete the top Family Information Section, you will need to complete the Add New Student Section before form can be submitted. Fee for the class is $20. Payments can be made in advance through Venmo @DanceArts-Merrick.com (it will say James Dale and have the Dance Arts logo) or by cash or credit card on the day of the class. If paying by credit card, cash discount not applicable. Please arrive 15 min before class to ensure class starts on time! Email donna@danceartsmerrick.com with any questions or you are unable to make it once registered.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	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: *
	Birth Date: *	(format=mm/dd/yyyy)
	Student Email:*
	School:	Grade as of September:
	Allergies (Leave blank if NONE):
	Primary Doctor:

Additional Information:

Release, Assumption of Risk and Waiver of Liability

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1. I am participating in a Fitness classes offered by a Fitness instructor(s). I recognize that all Fitness classes require physical exertion that may be strenuous and may cause physical injury, including death, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any Fitness classes. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in Fitness classes.
3. In consideration of being permitted to participate in Fitness classes, I agree to assume full responsibility for any risks, injuries or damages (known or unknown), property damage or loss of any kind in which I may incur as a result of participating in Fitness classes.
4. In further consideration of being permitted to participate in Fitness classes, I knowingly, voluntarily and expressly waive any claim I may have against the authorized Fitness Instructor(s) for any injuries or damages (known or unknown), property damage or loss of any kind, including death that I may sustain as a result of participating in any Fitness class.
5. This is a legally binding Release, Waiver, Discharge and Covenant Not to Sue (collectively "Release") the authorized Fitness Instructor(s) or Donna Carbone's Dance Arts for any injury, death, property damage or loss of any kind caused by my voluntary participation in any Fitness class. The Release, Waiver, Discharge and Covenant Not to Sue is made voluntarily by me, the undersigned Releaser, on my own behalf, and on behalf of my heirs, executors administrators, and legal representatives.
6. I have read the above release, waiver of liability and assumption of risk, fully understand its contents and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be the complete and unconditional release of all liability. I voluntarily agree to the terms and conditions stated above. This agreement remains in effect for as long as I participate in any Fitness class.