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Southeast Circus Retreat is a weekend program that is combining elements from a retreat, an apparatus meeting and workshop weekends. You are registering for the full weekend August 11 - 13. You will choose your specific classes in the Questions/Options section below.
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End Date/Time:
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Fee per Student:
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Room:
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* - denotes required fields |
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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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Questions/Options: |
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Additional Information: |
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Assumption of Risk
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I assume any and all risk of injury (serious or otherwise) for me or my child. I further agree that if someone else is harmed through my child’s actions and blames the gym/venue, its owners, or its employees, for his harm, I will indemnify, defend, and old harmless the gym/venue, its owners, or its employees.
In consideration of being permitted to participate in aerial dance activities including but not limited to Rope and Harness, Fabric and Trapeze (hereafter known as Aerial Dance Activities) at and/or under the auspices of Caroline Calouche & Co. / Charlotte Cirque & Dance Center, I do acknowledge, appreciate and agree that:
**The risk of injury resulting from Aerial Dance Activities is significant. The risk includes but is not limited to all manner of injury resulting from my falling during Aerial Dance Activities and hitting the floor, wall faces, people, rope, fabric, and fixtures – whether permanently or temporarily in place. This risk also includes, but is not limited to, rope/fabric abrasion, rope/fabric entanglement and burn, injuries resulting from falling and dropped items.
I do knowingly and freely assume all such risks both known and unknown, and I do knowingly and freely assume all responsibility for my participation in dance and cirque activities at and/or under the auspices of Caroline Calouche & Co. /Charlotte Cirque & Dance Center
I've read the above and agree.
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Hold Harmless
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I agree to release, hold harmless, and indemnify Caroline Calouche & Co. / Charlotte Cirque & Dance Center its owners and its employees from any and all harm. Further, I agree that if any lawsuit is filed against the Caroline Calouche & Co. / Charlotte Cirque & Dance Center its owners, or its employees, on account of my injuries, my child’s injuries or my child’s injuries to another on account of my child’s actions, I will defend, indemnify, and hold harmless Caroline Calouche & Co. / Charlotte Cirque & Dance Center its owners and its employees.
I've read the above and agree.
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Release of Liability
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I agree that Caroline Calouche & Co. / Charlotte Cirque & Dance Center its owners, officers, directors, employees, successors and agents shall not be liable for any harm my child may come to while on the premises of any educational programming, or for damage to their property. I hereby release, indemnify, and discharge Caroline Calouche & Co. / Charlotte Cirque & Dance Center on behalf of myself and/or my children, from any and all claims, demands, or causes of action, which are in anyway connected with my participation in this activity or my use of their equipment or facilities (except for gross negligence or willful misconduct).
Further, Caroline Calouche & Co. / Charlotte Cirque & Dance Center shall not be liable for any harm I or my child may come to, or any property loss that I or my child may incur, anywhere while using techniques learned in the studio and on location for an event, even though that harm may result from the participant’s negligence. I hereby release Caroline Calouche & Co. / Charlotte Cirque & Dance Center from any and all liability (except for gross negligence and / or willful misconduct) for such harm also.
I've read the above and agree.
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Illness
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I acknowledge that it is my responsibility as the participant or the parent/caregiver to make sure I am not bringing any person (my child, sibling, myself) into the facility with any symptoms of any illness. I understand that if any CC&DC staff member feels that any customer is showing signs of illness, they will be asked to leave the building immediately.
I've read the above and agree.
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Media Release
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I give my permission for photos and videos of me and/or my child(ren) to be used for marketing purposes.
I've read the above and agree.
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Right to Refuse Service
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I understand that Caroline Calouche & Co. /Charlotte Cirque & Dance Center reserve the right to refuse or terminate service to me or my child for any reason not discriminatory, at any time.
I've read the above and agree.
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Safety Rules
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I or my child have read the safety rules of Caroline Calouche & Co. / Charlotte Cirque & Dance Center and agree to abide by them. I or my child is in good health and has no physical or mental limitations that would preclude them from careful and reasonably safe use of the gym/venue.
I will comply with ALL rules both written and verbally stated to me by the Dance & Cirque Staff Caroline Calouche & Co. /Charlotte Cirque & Dance Center.
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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| eCheck/Bank Draft:
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Bank Name: |
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Bank Routing Number: |
(9-digit number)
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Your Account Name: |
(Your name on your bank statement)
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Your Account Type: |
Account Number:
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