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Broadway Master Class with one of the stars from the Broadway show PIPPIN ~ Saturday, April 18th 9:30-11:30am ~
Ages 11 & up / Level: Int to Advanced ~ $25 Academy Members / $30 Non-Academy Members ~ Please Note: If you enter a different credit card than that which is on file, the system will automatically change your card on file to the one you are providing. Please go to your portal and make sure the card on file is the one you wish to use.
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Family Information |
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Students entered below will be added to your family's account
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Release of Liability
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As the legal parent or guardian, I hereby release and hold harmless Mary Jo's Performing Arts 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 in route to or from any of said premises. I understand that appropriate physical contact is required during the instruction of dance, and I give permission for instructors to make appropriate physical contact with me or my child for such instruction.
I understand Mary Jo's Performing Arts Academy reserves the right to refuse my business without notice..
I've read the above and agree.
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Video & Photo Release
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I understand and acknowledge that, from time to time throughout the year; my child may be photographed and/or videotaped while participating in functions involving MJPAA. I do hereby authorize Mary Jo's Performing Arts Academy to use these photographs and videotapes for the purposes of illustration, advertisement and publication in any manner whatsoever.
I've read the above and agree.
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Assumption of Risk
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In case of emergency or sudden illness, I hereby give permission for a staff member of Mary Jo's Performing Arts Academy to authorize any physician, nurse practitioner, medical personnel or hospital to render immediate emergency aid as it might be required for the undersigned student's health and safety.
I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health.
It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the students own policy is the only source of reimbursement.
I've read the above and agree.
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Exp Year: *
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