Registration
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Please do not wear your dance shoes in from outside! Bring them, clean, to change into upon arrival. Barefoot, or socks are also acceptable.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Relation
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Student
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School District:
*
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):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School District:
*
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):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School District:
*
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):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School District:
*
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):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School District:
*
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):
Questions/Options:
Will you be attending our Kids Breaking Class (1:00 - 1:25 PM)?
Yes
No
Will you be attending out Teen/Adult Dance Sampler class (1:00 - 1:25 PM)?
Yes
No
Will you be attending our exclusive All Ages International Dance Day Jazz Funk class (1:30 - 2:20 PM)?
Yes
No
Will you be attending our Kids Dance Sampler class (2:30 - 2:55 PM)?
Yes
No
Will you be attending our Teen/Adult Breaking class (2:30 - 2:55 PM)?
Yes
No
Additional Information:
HOLD HARMLESS AGREEMENT
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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. I agree to indemnify and hold Body Language Studio, its instructors, employees, and owner harmless from any and all liability for injuries, property damage, or loss in connection with my/my child's participation in dance or fitness activities. I also hereby authorize Body Language Studio to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release them from any liability from injuries, illness or loss incurred.
I've read the above and agree.
COMMUNICABLE DISEASES RELEASE, INCLUDING COVID-19
(Show-Hide Details)
Participation in dance, movement, or fitness activities at Body Language Studio includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest staff member immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE AND HOLD HARMLESS Body Language Studio, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. If the participant is under the age of 18, I agree on their behalf as their parent/legal guardian.
I've read the above and agree.
DANCER DRESS CODE POLICIES
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I understand that proper dance shoes are suggested for dance. Only clean athletic shoes that are not worn outside are allowed on the dance floors. I/My student will need to come dressed for dance/fitness class, with hair up if necessary, etc.
I've read the above and agree.
PHOTO/VIDEO PERMISSION
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I expressly consent, release, and transfer to Body Language Studio, in advance, any and all rights to photographs and/or videos of myself/my student in class, on a live-stream, at performances, at all Body Language Studio-related events, and from professional Picture Days. I understand that Body Language Studio may use such photographs or video recordings for promotional purposes, on various media platforms; such assignment may survive the termination of this agreement. I also understand that Body Language Studio will never use my full name or the full name of my student in association with any photography or video I am/he/she is depicted in and that the context of such depictions will also be displayed in a positive and professional manner, in alignment with our core values.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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