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Fee per Student:
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Room:
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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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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Open Gym
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I agree to hold harmless from any and all liability the Gym Zone, it's members, officers or employees, both in their professional capacity and personally for any or all injury or illness resulting from participation in open gym, classes, and special events at the Gym Zone.
I've read the above and agree.
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Payment
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I agree to have the Gym Zone review and charge my card on file for Kid's Zone In Event.
I've read the above and agree.
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Waiver
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I grant permission to the staff of The Dance Factory, LLC (the "studio") to take first aid and or emergency measures as judged necessary for the care and protection of my child while under the supervision of the studio. In case of medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the emergency unit deems necessary. I understand that in some medical situations the staff may need to contact the emergency resource before the child's parent, physician, or other person acting on the parent's behalf. I also understand and agree that the child's parents or legal guardians shall be responsible for any expense incurred. As the parent/legal guardian, I agree to hold harmless from any and all liability the studio, its members, officers or employees, both in their professional capacity and personally for all injury or illness resulting from or in any way connected with his/her participation in the classes, activities or special events at the studio. I understand that it is the studio's policy that while under the supervision of the studio, no child is allowed to leave the building without a parent/legal guardian or the written permission of a parent/legal guardian and that the parent/legal guardian assumes full responsibility for the actions and behavior of the child. Parents/legal guardians give their permission to the studio to use photos and/or video of their child without remuneration in connection with studio publications, website, Facebook, advertising, TV and news coverage. (If you do not want your child's photo to be utilized for any marketing purposes, please submit a written statement to our office.)
I've read the above and agree.
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Other Questions/Comments: |
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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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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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