Registration
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Welcome to Living Arts Dance, Inc. Adult dance class registration form. Please complete the entire form below. Call 888.257.9992 or email info@livingartsdance.com if you have additional questions. Thank you.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
Grand Parent
Guardian
Mother
Parent
Self (Adult 18 & over)
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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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:
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Emergency Contact Info (Not Contact #1 or #2)
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Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
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:
Grade Level:
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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 :
Allergies :
Medications (Leave blank if NONE):
Use of photo allowed?:
*
Student May Be Released To?:
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Public Transportation Allowed?:
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Permission to give Medication:
*
Student sign themself In/Out?:
*
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:
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 :
Allergies :
Medications (Leave blank if NONE):
Use of photo allowed?:
*
Student May Be Released To?:
*
Public Transportation Allowed?:
*
Permission to give Medication:
*
Student sign themself In/Out?:
*
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:
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 :
Allergies :
Medications (Leave blank if NONE):
Use of photo allowed?:
*
Student May Be Released To?:
*
Public Transportation Allowed?:
*
Permission to give Medication:
*
Student sign themself In/Out?:
*
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:
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 :
Allergies :
Medications (Leave blank if NONE):
Use of photo allowed?:
*
Student May Be Released To?:
*
Public Transportation Allowed?:
*
Permission to give Medication:
*
Student sign themself In/Out?:
*
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:
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 :
Allergies :
Medications (Leave blank if NONE):
Use of photo allowed?:
*
Student May Be Released To?:
*
Public Transportation Allowed?:
*
Permission to give Medication:
*
Student sign themself In/Out?:
*
Questions/Options:
Adult 6 Week Session Class: Wednesdays Ballet- Jazz 8 pm - starts 7/10- 8/17 - Drop-In $15
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Yes
No
Adult 6 Week Session Class: Hip-hop Thursdays 8 pm - starts 7/11- 8/17- Drop-In $15
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Yes
No
Adult 6 Week Session Class: Adult Tap Saturdays 1 pm - starts 7/13 - 8/17- Drop-In $15
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Yes
No
Adult Private Lessons Rate - 30 minutes - $35.00, 45 minutes - $50.00, 60 minutes - $65.00
Adult Private Lesson: Please describe the amount of lessons you would like to purchase, duration, lesson genre, days of the week, times, and we will reach out via email to schedule your lesson.
Adult Showcase for all classes in the session Saturday, August 17th
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Yes
No
Total Rate:
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Drop-In Class Date
Additional Information:
Online Dance Discounts Class Registration
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New Year dance discounts will be available for purchase until Mon. Jan 11, 2020, 12 am. Online drop-in classes must be scheduled in advance, a minimum of 1 hour prior to the class, please call 888.257.9991 or email info@livingartsdance.com if you have questions or require additional information. Classes/private lessons purchased can be used for online only.
I've read the above and agree.
Registration
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Advance registration is required for all classes. For online classes dancer must be registered at least one hour prior to the class time to receive the class code and log instructions.
I've read the above and agree.
Purchase Agreement
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All payments are nonrefundable. One package per student. If you need to cancel or reschedule your lesson please give at least 2 hours notice via email. Dance class packages purchased expired 6 months from the date of purchase.
I've read the above and agree.
Liability Waiver Part 1
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Living Arts Dance Inc.
624 N. Front Street, 2nd & 3rd Floor, Philadelphia, PA 19123
Release and Waiver of Liability and Indemnity Agreement
(Read Carefully Before Agreeing)
In consideration of being permitted to participate in any way in the Living Arts Dance Inc. indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:
1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below Living Arts Dance Inc. classes, activities or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
2. I/WE fully understand and acknowledge that:
(a) There are risks and dangers associated with participation in Living Arts Dance Inc. classes, events and activities which could result in bodily injury partial and/or total disability, paralysis and death.
(b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
(c) These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.
(d) There may be other risks not known to us or are not reasonably foreseeable at his time.
3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
4. I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Living Arts Dance Inc. facility used by the participant , including its owners, managers, promoters, lessees of premises used to conduct the Living Arts Dance Inc. classes, events or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the Living Arts Dance Inc. facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as "Releasee"...FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE.
5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite thi
I've read the above and agree.
Liability Waiver Part 2
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5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
7. On behalf of the participant and individually, the undersigned partner(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite this release, the participant makes a claim against any of the Releasees, the parent(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
I've read the above and agree.
Photo Release
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I hereby consent that all photographs and/or video footage of myself which may be used by Living Arts Dance, Inc. for the purposes of illustration, advertising, or publication in any manner.
I've read the above and agree.
Studio Policies
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Enrollment -Enrollment is open to any and shall be granted without discrimination in regard to sex, race, color, religion, or political belief. However, Director and/or Owner reserves the right to send a student home or ask a patron to leave the property due to illness, disruptive behavior, risk of contagiousness, and in regards to the safety of others. There is a two class minimum for all classes.
Attendance- A parent, student, or patron must notify the Studios within 2 hours of lesson/session start time to be absent from a lesson. Missed days of dance can not be made up. Director should be notified if a child is ill. If there is inclement weather please call, a message will inform you if we are closed, there are no refunds for closers due to inclement weather. Students may not attend class if payments are past due or if not in proper uniform. Students who miss a month of classes must register again for classes.
Parent, siblings, friends, or spectator's access -Parents may be asked not watch lessons/rehearsal at anytime if their presence is disruptive. In cases where Family court or other legal entities have been established visitation or custody rights, a copy of the orders must be provided to Living Arts Dance & Fitness Studios. The orders of the court will be strictly followed unless the custodial parent/guardian requests a more liberal variation of the court order in writing. Visitors are allowed in the studio areas only at the discretion of the director. A staff member will accompany visitors at all times.
Arrival & Departure - Upon arrival and departure each parent, student, or patron must sign in and out on the appropriate sheet(s) in the foyer. Children are to be escorted to their designated area and dropped off with a supervisor at all times. Students may not be dismissed on their own without written parent consent. Parental involvement in helping your child get settled with a staff member will help your child adjust quickly to the routine. Students who are not picked up with 15 minutes of their class will be charge a late pick-up fee. Older students must not be responsible for younger siblings, only parents or guardians. Living Arts Dance Inc. is not responsible for students who linger before/after designated classes students will be asked to wait in the lobby area.
Accidents & Injury - Should a student become injured at school, the parent will be notified via an incident report form. The parent will be asked to sign this form indicating that he/she has been notified, and a copy of the form will be included in the student's school record. In the event of an injury, if the injury is of a serious nature, a parent will receive a phone call from the school at the time the accident occurs.
Field Trips - Periodic field trips will be planned to provide the students with exposure to the arts and learning experiences in our local community. Prior to each trip, information will be sent home outlining the date, time, cost, location, chaperones, etc. The permission slip must be signed and returned to the director by the date requested and the appropriate fees must be paid in order for the child to attend.
Smoking - It is our desire that the environment around the studios be as safe and as healthy as possible. Living Arts Dance Inc. building and grounds are smoke-free. Parents, staff, and visitors are asked to comply with this request.
Fire Arms & Weapons - Living Arts Dance Inc. grounds and building are to remain weapons-free, unauthorized possession of dangerous or illegal firearms, weapons or explosives on the property is forbidden.
Discipline - It is the policy of Living Arts Dance Inc. to keep disciplinary issues minimized and help students monitor their own behavior. Staff of the studios present age-appropriate behavioral guidelines and use reflective communication to encourage children to express their emotions. The staff encourages self-control, self-direction, responsibility, and cooperation. When it is pract
I've read the above and agree.
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