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The Holidays are coming! You need a moment to wrap presents, go shopping or just relax. Take that special someone on a date. At Parent's Night Out you get a whole 5 hours to yourself... yourselves. While you're enjoying your evening, your child(ren) will be play games, dance class, arts and crafts. Plus we'll take pictures and video of the evening and send them to you, You won't miss a thing. Currently registered families text us at (908) 892-1065 for a special discount rate. This event takes place at our Hillsborough location.
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Family Information
First Name:
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Last Name:
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Type
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Caregiver
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Self
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Emergency Contact Info (Not Contact #1 or #2)
Students entered below will be added to your family's account
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Student's First Name:
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Last Name:
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Student Gender:
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Allergies (Leave blank if NONE):
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Allergies (Leave blank if NONE):
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Student's First Name:
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Allergies (Leave blank if NONE):
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Student's First Name:
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Student Gender:
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Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
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Student Gender:
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Birth Date:
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Allergies (Leave blank if NONE):
Additional Information:
Waiver
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I understand that there are risks of physical injury associated with, arising out of, and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to David Kieffer LLC doing business as The Dance Connection, it's officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to as "The Dance Connection"). I hereby agree to release The Dance Connection and hold The Dance Connection harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in dance on behalf of myself or my minor child. I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation. I have had an opportunity to discuss this release with an attorney before signing it if I chose to do so.
I've read the above and agree.
Photo release
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I do hereby consent to the use by David Kieffer, LLC, doing business as The Dance Connection (collectively, the "Company") and its agents or employees, to use photographs taken of me (or my minor child) at the Company or any other location, by a professional photographer (a "Photographer") hired by the Company, or by Company employees or agents, to be used for any lawful purpose. I hereby waive the right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to any form of payment, compensation, royalties or any other form of consideration relating to the use of the photographs. I hereby release, defend and hold harmless the Company and its officers, directors, employees, agents and representatives of any kind, from and against any claims, damages or liability arising from or relating to the use of the photographs. I understand that the Company is not responsible for the acts or omissions of a Photographer and makes no representations or warranties of any kind regarding the quality of the pictures of me (or my minor child). I attest that I have read this consent form and fully understand its contents.
I've read the above and agree.
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