|
|
|
|
| | |
|
|
2024 Fairyland Magic Camp- June 17th-20 9am-12:30pm
|
|
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)
|
| | | |
|
Additional Information: |
|
| | | |
|
Assumption of Risk
(Show-Hide Details)
I UNDERSTAND THAT PARTICIPATING IN DANCE AND TUMBLING ARE PHYSICAL ACTIVITIES. I UNDERSTAND THAT INJURIES CAN HAPPEN WITH ANY PHYSICAL ACTIVITY. I DO NOT HOLD DANCE PRODUCTIONS - THE REMIX, LLC, ITS OWNER, OR ANY STAFF MEMBER RESPONSIBLE FOR ANY HEALTH/ACCIDENTAL INJURY. I AM TOTALLY RESPONSIBLE FOR MY CHILD'S OWN MEDICAL INSURANCE, HEALTH INSURANCE, AND/OR MEDICAL RELATED COSTS DUE TO POSSIBLE INJURIES OCCURRING AT DANCE PRODUCTIONS - THE REMIX, LLC, 5478 HUDSPETH DAIRY ROAD, HARRISBURG, NC 28075-OR AT ANY EVENTS SPONSORED BY THE SAME . I HEREBY GRANT PERMISSION TO DANCE PRODUCTIONS - THE REMIX, LLC, TO SEEK MEDICAL TREATMENT FOR THIS CHILD IF THEY ARE NOT ABLE TO REACH THE GUARDIAN OR EMERGENCY CONTACT. I WILL PROVIDE ANY SPECIAL MEDICAL RESTRICTIONS AND PHYSICIAN CONTACT INFORMATION UNDER SEPARATE COVER.
I've read the above and agree.
|
|
|
Covid Waiver
(Show-Hide Details)
Dance Productions - The Remix Supplemental COVID-19 and any Contagious Disease Waiver/Liability As a participant or as a parent/guardian of a participant of Dance Productions - The Remix dance programs, I recognize and acknowledge there are certain risks of physical injury and I agree to assume full risk of any injuries, including damages or loss which may be sustained as a result of participation in activities associated with Dance Productions - The Remix. I agree to waive and relinquish all claims against Dance Productions - The Remix and its faculty members from any and all claims resulting from participation in the programs offered. I acknowledge the contagious nature of COVID-19 and any other contagious diseases and viruses and voluntarily assume the risk that I and/or my children may be exposed to or infected by COVOD-19 by attending and participating and that such exposure or infection may result in personal injury, illness, disability, and/or death. I understand that the risk of becoming exposed or infected by COVID-19 and other contagious diseases and viruses, as always, may result from the actions, omissions, or negligence of myself and/or others, including, but not limited to, employees, volunteers, and program participants and their families. I have read and understand this policy and agree to assume these risks and liabilities. Signature of Parent/Guardian/Dancer (18 ) Print Name
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:*
|
| | | |
|
Please Wait...
|
|
| |