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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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Payment
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The event fee will automatically be withdrawn using the card you used to register, the day before the event. If the card is declined, you will not be able to attend the event.
I've read the above and agree.
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COVID-19 Disclosure
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I agree to verify prior to the event that my child has not recently had a fever, cough, shortness of breath, sore throat, muscle aches or chills and has not been in direct contact with anyone that has been diagnosed with COVID-19. I agree to follow all protocols established by the studio. I understand I am assuming the risk of my child's health and will not hold Artistic Fusion Dance Academy LLC should my child become exposed or infected with COVID-19.
I've read the above and agree.
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Assumption of Risk
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I recognize and understand the risks of physical injury inherent to dance and dance training and I fully assume those risks. I hereby release Artistic Fusion Dance Academy LLC, its affiliate dance studios, event sponsors, employees, dance teachers, and volunteers from all liability for injuries sustained or illnesses contracted by me while attending or participating in any dance classes, workshops, or performances. I agree to indemnify, defend, and hold harmless Artistic Fusion Dance Academy LLC, its affiliate dance studios, event sponsors, employees, dance teachers, and volunteers for liabilities, costs and judgments arising from acts of omissions committed by me which result in injury or damage to any person or property. I understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in any classes, workshops, performances, or related activities. I hereby release Artistic Fusion Dance Academy, its affiliate dance studios, event sponsors, employees, dance teachers, and volunteers from all liability for loss or damage to my personal property while attending or participating in classes or dance workshops, performances or related activities. I also agree to abide by any rules, regulations and policies set forth by Artistic Fusion Dance Academy.
I've read the above and agree.
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Release of Liability
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I understand and agree that it is my sole responsibility to safeguard my personal property while attending or participating in any classes, workshops, performances, or related activities. I hereby release Artistic Fusion Dance Academy LLC, its affiliate dance studios, event sponsors, employees, dance teachers, and volunteers from all liability for loss or damage to my personal property while attending or participating in classes or dance workshops, performances or related activities. I also agree to abide by any rules, regulations and policies set forth by Artistic Fusion Dance Academy LLC.
I've read the above and agree.
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Medical Emergencies
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In case of physical injury or medical emergency, I hereby authorize Artistic Fusion Dance Academy LLC to make necessary arrangements to transport my child or me to a medical treatment facility as necessary. All such transportation and medical treatment will be at my sole cost and expense. In extreme emergency, or if I am under 18 years of age, I understand that Artistic Fusion Dance Academy LLC will attempt to notify the person(s) I have named below as my emergency contact(s) of my condition and how to reach me. In signing this release, I acknowledge and represent that I have fully informed myself of the content of the waiver and hold harmless agreement by reading it before I sign it, and I understand that I sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from the written statement, have been made. I further state that I am at least eighteen (18) years of age and fully competent to sign this agreement; and that I execute this release for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related reasons or problems that preclude or restrict my participation in this activity, and that I will pay any medical costs that may be attendant as a result of injury to me.
I've read the above and agree.
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Photography Release
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As a registered observer, I acknowledge and understand that individual Board/Faculty members may prohibit videography or the taking of photos in their classes or any events that I am admitted to. I agree that I will honor any such restrictions imposed and I will not hold Artistic Fusion Dance Academy LLC responsible nor will I expect an adjustment or reduction in any fees I have paid or agree to pay. Artistic Fusion Dance Academy LLC reserves the right to use photographs, taken either in class or of students participating in class and/or their art, for the purposes of instruction, advertising and promoting Artistic Fusion Dance Academy LLC and it’s programs. Students, or parents of students who are minors, who do not wish to comply with this policy must notify a representative of Artistic Fusion Dance Academy prior to participation in class.
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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