Registration
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Come let your little one explore, dance to music and have fun at our open studio dance & play. Our teachers will go in and lead a fun activity every 20minutes.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Additional Information:
Release of Liability
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As the legal parent or guardian, I release and hold harmless Bravo Dance Academy its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury including death, that may be sustained by the participant and/ or the undersigned, while in or upon the premises or any premises under the control and supervision of Bravo Dance Academy its owners and operators or in route to or from any said premises.
I've read the above and agree.
Medical Emergency
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The undersigned permission to Bravo Dance Academy, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/ mental problems, restrictions, or condition and/ or declare the participant to be in good physical and mental health. I acknowledge the contagious nature of COVID-19 and other contagious diseases and viruses and voluntarily assume the risk that I and/ or my children may be exposed to or infected by COVID-19 or any another virus by attending and participating and that such exposure or infection may result in personal injury, illness, etc. I understand that the risk of becoming exposed or infected by COVID-19 and other contagious diseases and viruses may result from the actions, omissions, or negligence of myself and others, including, but not limited to, employees, volunteers, and program participants and their families.
I've read the above and agree.
Photography Release
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As the legal parent or guardian, I agree that Bravo Dance Academy may take and use photographs and videos of my child for any lawful purpose related to the company, including for example such purposes as publicity, illustration, advertising, and Web content (social advertising).
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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