Registration

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Weekly registration. sign up per student.
A mix of all different types of Ballroom Dance styles.
Make sure to wear flat sole/ non-sharp heels.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

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

	Address: *
	City: *	State: * Zip: *

Students entered below will be added to your family's account

Questions/Options:

Additional Information:

Payment Policy

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I've read the above and agree.

Waiver

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By signing below, I VOLUNTARILY AGREE AND PROMISE TO ACCEPT AND ASSUME ALL RESPONSIBILITIES AND RISK FOR INJURY, ILLNESS, OR DAMAGE TO MYSELF/ MY CHILD OR TO MY/ MY CHILD'S PROPERTY arising from my/ my child's participation in any activities during a DYNAMIC MOVEMENT ACADEMY program. My/ my child's participation is purely voluntary; no one is forcing me/my child to participate. I verify that my/ my child's health and mental/physical condition will not in any way hinder my/his/her participation or the participation of others. I further agree to accept responsibility for ALL expenses related to any accident, injury, illness, or property damage experienced or caused by myself/ my child. I FURTHER AGREE AND PROMISE TO HOLD HARMLESS AND TO INDEMNIFY DYNAMIC MOVEMENT ACADEMY their agents, employees, and all other persons or entities from all defense damage which I may negligently or intentionally cause to spectators or other third parties in the course of my participation in this activity. I FURTHER AGREE AND PROMISE NOT TO USE, assert or otherwise maintain any claim against DYNAMIC MOVEMENT ACADEMY, their agents or employees, and all other associates, for any injury, death, illness, disease, or damage to myself or to my property, arising from or connected with my participation in this activity or from any claims asserted against me by spectators or other third parties. In signing this document, I FULLY RECOGNIZE THAT IF ANYONE IS HURT OR DIES, OR PROPERTY IS DAMAGED WHILE I AM ENGAGED IN THIS ACTIVITY, I WILL HAVE NO RIGHT TO MAKE CLAIM OR FILE A LAWSUIT AGAINST DYNAMIC MOVEMENT ACADEMY, their AGENTS OR EMPLOYEES, EVEN IF their AGENTS OR EMPLOYESS NEGLIGENTLY CAUSE THE INJURY OR DAMAGE. I UNDERSTAND AND ACKNOWLEDGE THAT NO MAJOR MEDICAL INSURANCE BENEFITS WILL BE PROVIDED TO ME DURING THIS ACTIVITY by DYNAMIC MOVEMENT ACADEMY or any other entity. I certify that I have sufficient health, accident, and personal liability insurance to cover any bodily injury or property damage received as a result of my participation in this activity. Whether or not I have such insurance, I verify that I WILL personally pay for ANY and ALL such expenses or liability. I FURTHER ACKNOWLEDGE that I /my child am/is in good physical and mental health and am not suffering from any condition, disease, or disablement which would potentially affect the participation or safety of myself or others.

I've read the above and agree.

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