Registration
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Three fun filled days to keep your busy bees moving, creating, giggling and making new friends over Spring Break. We will create masterpieces, plant and grow together, perform science experiments and of course dance! We will learn a themed dance to perform for parents/caregivers at the end of camp everyday.
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Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
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Self
Home Phone:
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Email:
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Address:
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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 Email:
School:
Grade Level:
preschool
kindergarten
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3rd grade
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5th grade
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Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
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Disabilities (Leave blank if NONE):
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Medications (Leave blank if NONE):
Primary Doctor:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Questions/Options:
Please list any known allergies or special accommodations needed for your child here
Additional Information:
Release of Liability
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In consideration of my child's participation with Studio 9 Dance Academy, with full understanding of the risks involved, I hereby release, waive, discharge, covenant not to sue, and agree to indemnify, save and hold harmless S9DA and all of its owners, directors, officers, employees, agents, instructors, contractors, representatives, volunteers and executors (hereinafter collectively referred to as "S9DA Representatives"), from any and all liabilities, claims, demands, losses, attorney's fees, damages, action and causes of action whatsoever arising out of or related to any loss, damage, or injury including death, that may be sustained by my child , whether caused by the negligence of S9DA Representatives or otherwise while participating with S9DA, on behalf of S9DA, or upon other premises where S9DA activites are being conducted. I agree to take no legal action against S9DA o rS9DA Representatives because of any accident or mishap involving the athletic participation of my child, and I authorize emergency medical treatment for my child should the need arise. This release applies to, including by not limited to, any act or occurrence that is caused by, or alleged to be caused by, by the negligence of S9DA including rescue or medical procedures. I further agree that if, despite this release, I, my child, or anyone on my child's behalf makes a claim against S9DA, I will indemnify, save, and hold harmless S9DA from any litigation expenses, attorney fees, loss, liability, judgment, damage, or any cost that may occur as the result of any such claim.
I've read the above and agree.
Payment Policy
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Spring break Camp Tuition is due at the time of registration. If a registration is cancelled within 30 days of the camp start date, refunds or credits will not be given. If a registration is cancelled prior to 30 days before the camp start date, credits may be given to family account; monetary refunds for camp registration will not be issued.
I've read the above and agree.
Medical Treatment Release
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In any event of an accident or emergency, I authorize Studio 9 Dance Academy and/or any appropriate medical facility to take whatever emergency measures (first aid, disaster evacuations, etc.) as judged necessary for the care and protection of my child under under the supervision of Studio 9 Dance Academy. In the case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resources (police, rescue squad, first responder, ambulance, etc.) deem it necessary. The child will be transported at my expense. I understand that in some situations, the staff will need to contact the local emergency resource before the parent, child's physician and/or other adult acting on the parent's behalf. I understand and agree that I am responsible for all medical expenses incurred to treat my child's injuries. I further authorize and consent to the use orf disclosure of my child's individually identifiable health information should treatment for illness or injury become necessary. Should my child to be transported to a hospital for medical treatment, I hold Studio 9 Dance Academy and it's representatives harmless for any such expenses. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by me or my child(ren) as a result of any injury sustained while participating at or for Studio 9 Dance Academy.
I've read the above and agree.
Photo and Video Release
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Studio 9 Dance Academy reserves the right to use any images of your child, including but not limited to photos and videos, for promotional, marketing and advertising materials. This includes posting on Studio 9 Dance Academy's website and other social media pages.
I've read the above and agree.
Assumption of Risk
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I, by checking the box below, represent that I am the minor child's (hereinafter "child") parent or legal guardian. I also represent that I am authorized to sign this waiver. I authorize my child's participating and training in dance at Studio 9 Dance Academy (S9DA) including the use of its facility and equipment. I understand and acknowledge the nature of the activities my child will be involved in at S9DA. I understand and acknowledge that participation in dance involves a risk of injury and I agree as my child's parent or guardian to assume all risks in connection with my child's participation in dance classes, lessons, performances and competitions. I further understand that participation in dance is potentially dangerous and involves risk of serious injury, even death. Due to the dangers of this activity, I understand the importance of my child's following the teacher's instructions regarding techniques, training, and other rules and agree my child will obey these instructions. In consideration for allowing my child to participate, I assume all the risks associated with the sport of dance. I choose to accept such risks, and I voluntarily accept any and all responsibility for my child's safety and welfare while participating in S9DA. I understand my child's experience, physical health and capabilities. By checking below, I agree that my child is qualified, in good health, and in proper physical condition to participate in such activities.
I've read the above and agree.
Electronic Signature
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By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
I've read the above and agree.
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