Registration
Thank you for registering for a SDF Out of the Box Hip Experience, The Winter Workshop With Dexter Carr.
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
 
Additional Information:
 
Assumption of Risk
In consideration for permitting the undersigned to participate in Sean's Dance Factory Winter Workshop (the Activity), the undersigned voluntarily releases, discharges, waives, relinquishes all claims, and covenants not to sue Sean's Dance Factory, its owners, agents, employees and contractors from all liability to the undersigned and all his/her personal representatives, assigns, heirs, and next of kind for any loss or damage, and any claim or demands therefore on account of injury to the person or property of the undersigned whether caused by the negligence of Sean's Dance Factory or otherwise while the undersigned is engaged in the Activity.
I've read the above and agree.
 
Release of Liability
In consideration of the benefits derived from Sean's Dance Factory I do hereby agree to indemnify and hold harmless, release, and discharge Sean's Dance Factory and its staff from any and all claims of personal injuries, property loss or damages sustained by me/my child while participating in activities with Sean's Dance Factory and its staff. I authorize emergency first aid care for myself/my child in the event that I/(s)he becomes ill or injured while attending Sean's Dance Factory activities. I further authorize Sean's Dance Factory and its staff to retain the services of an MD or other qualified medical personnel to treat me/my child in the event of a medical emergency. I agree to inform Sean's Dance Factory in writing of any physical limitations and/or medical conditions that I/my child has, whether or not those conditions restrict my/my child's full participation.
I've read the above and agree.
 
Photography Release
SDF uses photographs and videos of its own dancers in its marketing and promotional materials. However, SDF will not include names of any dancers under the age of 18 beside a photograph or video unless specific permission from a parent/guardian has been obtained. You are granting SDF full permission to take, use, reproduce, and publish photographic, video, and digital images of your student (collectively "Images") for SDF marketing and promotional purposes during and after the student's participation in SDF programs. Further, you acknowledge that SDF shall be the exclusive owner of all rights, including copyright, in the images, and you irrevocably transfer, assign, and otherwise convey to SDF your entire right, title, and interest, if any, in and to the Images and all copyrights and other intellectual property rights in the Images.
I've read the above and agree.
 
Authorization for Payment
I hereby authorize Sean's Dance Factory for the one-time payment amount of $25.00. I realize that this amount is non-refundable within 48 hours of the anticipated start time of the event. In the event of cancellation, I will notify the administrator at info@seansdancefactory.com.
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*