Registration
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"Bring a grown-up to dance day!" Dance 101 invites you to take class with your favorite dancer. When: Join your favorite dancer during their regular class time the week of November 18 - 23, 2024. What: Guests will be dancing with us the entire class time. Guests must be dressed ready to move in comfortable clothing, socks and tennis shoes. Who: Only one guest per student/class. Guests must be at least 18 years of age. Participants must be registered prior to attending.
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
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Family Information
First Name:
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Last Name:
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Type
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Father
Grandparent
Guardian
Mother
Parent
Self
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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CO
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DE
FL
GA
HI
IA
ID
IL
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ME
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PA
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TN
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Zip:
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Emergency Contact Info
Add New Student #1:
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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
Other
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Special Needs (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
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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
Other
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Special Needs (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
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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
Other
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Special Needs (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
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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
Other
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Special Needs (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
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Student Gender:
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Female
Male
Other
Birth Date:
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(format=mm/dd/yyyy)
Student Email:
Special Needs (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
What is the name of the grown up who is participating in class?
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What is the name of your student(s)?
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What class(es) will you be participating in?
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I am 18 years of age and I understand that I will be dancing and participating in class with my student.
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Yes
No
I understand that there will be photos and videos taken at this event by Dance 101 staff and other participants that may be used and displayed on social media and/or shared by others.
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Yes
No
I wish to declare the following medical conditions.
Additional Information:
Release of Liability and Assumption of Risk
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I and/or my minor child (“I” or “participant”) desires to participate in dance or other exercise activities (the “Enrolled Activities”) provided or sponsored by Emily Finch, LLC doing business as Dance 101 (“Dance 101”).
I understand that the Enrolled Activities require physical exertion, and that physical injury may result from participating in the Enrolled Activities. Further, I am aware and understand that the Enrolled Activities involve the risk of personal or psychological injury, pain, and suffering, temporary or permanent disability, death, property damage, and/or financial loss (collectively, “Injuries”). I acknowledge that any Injuries I sustain may result from or be made worse by the actions, omissions, or negligence of Dance 101. I understand that Dance 101 cannot guarantee that I will not sustain Injuries during participation in the Enrolled Activities and that participating in the Enrolled Activities may increase participant’s risk of injury. DESPITE THIS RISK, I AM VOLUNTARILY PARTICIPATING IN THE ENROLLED ACTIVITIES, AND I VOLUNTARILY ELECT TO ASSUME ALL RISK INVOLVED. Enrolled Activities includes, without limitation, classes, recitals, competitions, and any open house or other event held, sponsored, hosted, or participated in by Dance 101.
I expressly waive and release Dance 101, its owners, managers, agents administrators, instructors, successors and assigns (the “Releasees”) from any and all liability, claims, demands, and causes of action (collectively, “Claims”) whatsoever, arising out of or related to any Injuries that may be sustained by the participant, arising from or related to participation in Enrolled Activities or being in or upon any premises under the control and supervision of Dance 101, its owners, administrators, and instructors (the “Premises”), whether arising out of the ordinary negligence of Dance 101 or any Releasees or otherwise. I further release and hold harmless Dance 101, its owners, administrators and instructors from any and all Claims, arising out of or related to any Injuries, that may be sustained by any other person while in or upon the Premises. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that Arizona law does not permit to be released by agreement.
I will defend, indemnify, and hold harmless Dance 101 and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, the costs of enforcing any right to indemnification under this agreement, and the cost of pursuing any insurance providers, incurred by Dance 101 and all other Releasees arising out or resulting from any claim of a third party related to participation in Enrolled Activities, including any claim related to participant’s negligence or the ordinary negligence of Dance 101.
I've read the above and agree.
Medical Emergency and Physical Condition
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I hereby certify that participant is in proper physical and mental condition to participate in the Enrolled Activities. I agree to notify Dance 101 immediately and in writing if there is any physical or mental condition that significantly impairs my ability to participate in the Enrolled Activities. I will work with Dance 101 to request a reasonable accommodation for any such issues. I give Dance 101, its owners, administrators and teachers permission to seek emergency medical treatment for participant, and I request that participant be transported to the nearest hospital if necessary. I understand that I am solely responsible for all costs related to such medical treatment and any related medical transportation. I understand that Dance 101 cannot dispense any form of medication. I release, forever discharge, and hold harmless Dance 101 and all other Releasees from any claim based on such medical treatment or other medical services.
I've read the above and agree.
Covid-19 Policy
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I am also aware of the contagious nature of bacterial and viral diseases, including COVID-19 and other infectious diseases (collectively, “Diseases”) and the risk that I may be exposed to or contract Diseases by being on the Premises and engaging in the Enrolled Activities, which may result in Injuries. I understand that this release also covers Claims caused entirely or in part by Dance 101’s failure to follow safety precautions or its failure to take additional precautions, including but not limited to negligence, mistake, failure to enforce its rules/policies, and failure to supervise. I also warrant to Dance 101 that I will abide by their rules and policies, including not entering the Premises if I have a fever or other flu-like symptoms. I further warrant to Dance 101 that I have adequate health, property, and liability insurance necessary to provide for and pay any medical costs or property damage that may directly or indirectly result from participation in the Enrolled Activities. I will also indemnify and hold Dance 101 harmless for any damages I may cause. I understand that the recommended protocols and risks for Diseases, especially COVID-19 are constantly changing. I understand that Dance 101 has no reliable way to stay fully updated on all of this information. Nor is it practicable or reasonable to fully implement every possible safety precaution. I understand that Dance 101 cannot guarantee that I will not become infected with Diseases while on the Premises or during participation in the Enrolled Activities and that being on the Premises and engaging in the Enrolled Activities may increase my risk of contracting Diseases.
I've read the above and agree.
Photo/Video Release
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I understand that from time to time, Dance 101 participants will be photographed and/or videotaped while participating in any Dance 101 Enrolled Activities. I further understand that these photos and videos may be used for appropriate promotional purposes for Dance 101. These videos and/or photos may also be made available for purchase from Dance 101. This specifically includes, without limitation, any photos or videos of the Annual Recital and any group photos. I hereby authorize Dance 101 and any Dance 101 hired photographers and videographers to take photographs of and videotape me and/or participant at recitals and other similar types of performances, including practices for such performances. I hereby waive any right to inspect or approve any image, and I hereby grant Dance 101 the unconditional right to use and copyright such photographs and videos and to sell such videos or photos. Participants’ last names will not be used on the Dance 101 website or in Dance 101 print advertising.
I've read the above and agree.
Instructor Feedback and Correction
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I understand that in the instruction of dance, the instructor may need to physically manipulate the participant when assisting the participant in the proper alignment and execution of the movements. I hereby authorize the instructors to physically manipulate the participant to assist in the proper alignment and execution of the movements.
I've read the above and agree.
Email List / Privacy Policy
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For your convenience, Dance 101 will periodically send account statements, newsletters or other announcements regarding specials, new products and services or changes to the Dance 101 privacy policy via email. You hereby agree to receive such emails and understand that you can opt-out (unsubscribe) at any time. Unless required by law, NONE of your personal information will ever be shared with a third party.
I've read the above and agree.
Acknowledgment of Understanding and Electronic Signature
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I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS AND HEREBY FREELY AND VOLUNTARILY AGREE TO ALL OF THE TERMS WITHIN THIS AGREEMENT, INCLUDING THE UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I, the undersigned, am at least 18 years of age and I am the participant, participant's parent, or participant's legal guardian. I have the legal right to consent to and, by signing, I hereby do consent to the terms and conditions of this Agreement. I understand that by checking each of the boxes above, I am electronically signing with the intent to document my agreement to each of the above terms.
I've read the above and agree.
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