Registration

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Thank you for attending an Ultimate Dance On The Move Birthday Party! All birthday party guests must complete waiver before attending a party. Current families do not need to sign as they have already done so at class registration.

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 (Not Contact #1 or #2)

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: *	Birth Date: * (format=mm/dd/yyyy)
	Grade Level:*
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Questions/Options:


Date of Birthday Party?*
Name of Participant?*

Additional Information:

Liability Waiver

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I've read the above and agree.

Photo/Video Waiver

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I've read the above and agree.

COVID Liability Release

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ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies have put in place recommended social distancing, occupancy restrictions and guidelines for businesses to follow. Ultimate Dance On The Move LLC has put in place preventative measures to reduce the spread of COVID-19; Ultimate Dance On The Move LLC will be implementing all recommendations from Illinois state officials as per Ultimate Dance On The Move’s Sanitation Practices & COVID procedures Guidelines document available on our website.

Ultimate Dance On The Move will make every effort to keep our studio sanitized and to prevent symptomatic employees and dancers from entering the building. However COVID-19 has been proven to be asymptomatic in some persons. Therefore, Ultimate Dance On The Move cannot guarantee that you or your child(ren) will not become infected with COVID-19 or any other unknown virus. Further, attending Ultimate Dance On The Move could increase your risk and your child(ren)'s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Ultimate Dance On The Move and that such exposure or infection may result in personal injury, illness, permanent disability, and death. By signing this agreement, I agree that my child and any accompanying persons will not enter Ultimate Dance On The Move if we exhibit any of the following new or worsening signs or symptoms of possible COVID-19: A temperature greater than 100.4 degrees Fahrenheit, cough, shortness of breath or difficulty breathing, other respiratory symptoms, or at least two of the following symptoms: chills, repeated shaking with chills, muscle pain, sore throat or new loss of taste or smell. I also agree that, neither my child(ren) nor any accompanying adult will enterUltimate Dance On The Move if we have had known close contact with a person who is lab-confirmed to have COVID-19.

I've read the above and agree.

Enter your Full Name: