|
|
|
|
| | |
|
|
Reinforce X Imperium
Industry Summer Intensive 2023
Mini Intensive for ages 7-10
June 9th 10:15am - 11:45am
2 mini classes for $99!
Early bird rates end April 26th (rate increases to $150 after)
Faculty includes . . .
Sienna Lyons, Mark Villager, and Ben Bigler. See our website for their bios and extensive experience.
|
|
Event: |
|
|
Start Date/Time: |
End Date/Time:
|
|
Fee per Student:
|
Room:
|
|
* - denotes required fields |
|
Family Information |
|
|
|
| | | |
| | | |
|
Students entered below will be added to your family's account
|
|
Add New Student #1:
(Show-Hide Details)
|
|
Add New Student #2:
(Show-Hide Details)
|
|
Add New Student #3:
(Show-Hide Details)
|
|
Add New Student #4:
(Show-Hide Details)
|
|
Add New Student #5:
(Show-Hide Details)
|
| | | |
|
Questions/Options: |
|
|
| |
| | | |
|
Additional Information: |
|
| | | |
|
Risk and Waiver of Liability
(Show-Hide Details)
Yes, my daughter/son/ward has my permission to attend master classes at Imperium House of Dance Inc.
To the extent permissible by law, I/we hereby release, discharge and/or otherwise hold harmless and indemnify Imperium House of Dance Inc., it's owners, officers, directors, teachers, employees, and associated personnel, from and against any and all demands, claims, and causes of action arising, directly or indirectly, from my or my child's/ward's participation in its classes and/or programs. THIS RELEASE SPECIFICALLY INCLUDES ANY DEMANDS, CLAIMS AND CAUSES OF ACTION ARISING OUT OF THE PAST OR FUTURE NEGLIGENT ACTS AND/OR OMISSIONS OF IMPERIUM HOUSE OF DANCE INC. , IT'S OWNERS, OFFICERS, DIRECTORS, TEACHERS, EMPLOYEES, AND ASSOCIATED PERSONNEL.
I've read the above and agree.
|
|
|
Marketing Release
(Show-Hide Details)
Occasionally Imperium House of Dance Inc. uses photos and/or videos of its students in social media, its website, or other marketing mediums. I understand that my child's likeness may be used in such advertising. These images will be used for Imperium House of Dance Inc. purposes only and will not be given or sold to outside companies or individuals.
I've read the above and agree.
|
|
|
Parent/Guardian Signature
(Show-Hide Details)
I have read and understood the RISK AND WAIVER OF LIABILITY, MEDICAL AUTHORIZATION, MARKETING RELEASE, AND AGREEMENT OF POLICIES. In addition, I confirm that I am the parent/legal guardian of the is registrant(s).
I've read the above and agree.
|
|
| | | |
|
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:
|
| | | |
| | | |
| eCheck/Bank Draft:
| |
|
Bank Name: |
| |
|
Bank Routing Number: |
(9-digit number)
| |
|
Your Account Name: |
(Your name on your bank statement)
| |
|
Your Account Type: |
Account Number:
| |
| |
|
Please Wait...
|
|
| |
