Registration

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Join us for free classes in celebration of International Dance Day!

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: *
	: *	Birth Date: * (format=mm/dd/yyyy)
	Adult Student or Parent/Guardian Email:*
	School Name or N/A:*	Grade as of Season Start Date or N/A:*
	Any impairment or disability the teacher should know?:
	Allergies we need to be aware of? i.e. nut allergy (or type NONE):*
	Medications we need to be aware of? i.e. inhaler (or type NONE):

Questions/Options:


Do you give permission for your child to be photographed/recorded at the event for the use of promotional materials? This will not exclude any child from the event. We will abide by your preference.*

Additional Information:

RELEASE AND WAIVER OF LIABILITY

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I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND CONSTITUTES A CONTRACT BETWEEN ME AND INTEGRITY 360 DANCE CENTER "COMPANY".

I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT DURESS OR COERCION AND I AM AND HAVE BEEN FULLY INFORMED OF THE CONSEQUENCES OF MY SIGNATURE HERETO.

I am a voluntary participant for the event/services to occur at 3894 Due West Road, Suite 115, Marietta, GA 30064 with Integrity 360 Dance Center information.

I AM AWARE THAT PARTICIPATION IN THIS EVENT/SERVICES MAY INVOLVE INTERACTION THAT COULD POTENTIALLY LEAD TO INJURY, SICKNESS OR EVEN DEATH. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES AND INTERACTIONS WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH, PROPERTY DAMAGE, OR OTHER LOSS, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. I AM EXPRESSLY ASSUMING THE RISKS ASSOCIATED WITH MY PARTICIPATION IN THIS ACTIVITY. I AM EXPRESSLY ASSUMING THE RISKS ASSOCIATED WITH THE CURRENT COVID-19 PANDEMIC AND CONTINUE THIS ACTIVITY AGAINST CENTER FOR DISEASE CONTROL AND/OR GOVERNMENTAL DIRECTIVES.

I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death, or loss of personal property and expenses as a result of those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this activity.

I hereby waive, release, and forever discharge COMPANY ("Released Parties") from any and all claims I may have now or arising in the future related to my participation in the event/services. I covenant and agree not to sue any Released Parties for any such claims. I hereby waive, release and forever discharge the Released Parties from all of the following (the "Claims"): any and all claims, liabilities of every kind, demands, damages (including direct, indirect, incidental, special and/or consequential), losses (economic and non-economic), and causes of action, of any kind or nature, which I have or may have in the future (including court costs, attorneys' fees and litigation expenses), that may arise out of, result from, or relate to my participation in the session or my travel to and from such activities . I understand and acknowledge that these Claims include, but are not limited to, causes of action for death, personal injury, partial or permanent disability, negligence, and property damage or theft; causes of action relating to the provision of first aid, medical care, medical treatment, or medical decisions; and claims for medical or hospital expenses, including medical transportation services. I understand and agree that the foregoing waiver, release and discharge applies even if the Claims are caused by the negligent acts, omissions, or carelessness of any Released Parties. I understand that this waiver, release and discharge operates for myself as well as on behalf of my spouse, children, parents, guardians, heirs, next of kin and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on my behalf. I further agree to indemnify and hold harmless all released parties from any claims which I might make or which might be made on my behalf by others or which might be made against me by others, arising from my participation in the activities provided by the released parties, my travel to or from such activities.

This waiver shall remain valid unless expressly revoked by the participant or parent or guardian of a minor, in writing, with receipt acknowledged by the released parties.

*Parent or Guardian Release or Waiver (Attached to the above waiver and release)*

I represent and warrant that I have the authority to give this release.

I am the parent or guardian and on the minor's behalf

I've read the above and agree.

COMMUNICATIONS PERMISSION

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I've read the above and agree.

Enter your Full Name: