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Dance, craft, games & pizza
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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Family Last Name
First Name:
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Last Name:
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Relationship to Student
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Aunt
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Email:
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Address:
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City:
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State:
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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:
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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:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Medical Conditions (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:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Medical Conditions (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:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Medical Conditions (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:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Medical Conditions (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:
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-freshman
college-junior
college-senior
college-sophomore
kindergarten
pre-K
preschool
Medical Conditions (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Additional Information:
Photographs/Videos/Marketing 2024-2025
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I understand that photographs and/or videos of my child/children and/or their class(es) may be taken for the promotion of the JMAD. I agree that they may be used for, but not limited to brochures, literature, newspaper advertising, website, social media accounts, etc. with the exception of Tik Tok and YouTube accounts which will require separate written permission from me. No compensation will be provided for such use. I understand that my child's name will not be included with the photographs, unless the director of JMAD obtains separate permission from me.
I've read the above and agree.
Medical Emergencies 2024-2025
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• I have to the best of my knowledge, included all known medical conditions, allergies, and disabilities for my child/children in my Parent Portal and will communicate any changes or treatment needed, so that JMAD staff and instructors will able to create a safe environment beneficial to my child/children's health and growth,
• In the event of a life threatening medical emergency involving my child/children, I give my consent for the staff and/or instructors at JMAD to immediately contact emergency services, without seeking any further permission from me, and understand I will be notified as soon as emergency services have been contacted.
• In the event of a non-life threatening accident or illness involving my child/children, I will be notified immediately. In the event that neither I nor my designated emergency contact can be contacted, I hereby give the staff of the Joy McDaniel Academy of Dance and Gymnastics my permission to seek medical attention for my child, including treatment by physicians, hospitals, or any other medical services.
• In such an event, I further agree that the cost of such medical service shall be borne exclusively by myself.
• I further agree to release and hold harmless JMAD, its affiliates, owners, officers, directors, managers, instructors, employees, agents, and attorneys from any and all damages, actions, charges, suits, expenses, claims, obligations, and liabilities from contacting emergency services or obtaining medical services on behalf of my child, from not contacting emergency services or obtaining medical services on behalf of my child, from any decision regarding the nature of an injury or illness involving my child/children, and from contacting or not contacting a parent/legal guardian.
I've read the above and agree.
Assumption of Risk and Release of Liability 2024-2025
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I understand that dance & gymnastics are physical activities that could cause injury. The risk of injury while participating is significant including the potential for permanent paralysis and death, and while the guidelines, equipment and personal discipline may reduce this risk, the risk of serious injury does exist and I KNOWINGLY AND FREELY AM ALLOWING MY CHILD(REN) TO PARTICIPATE AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEE or others, and assume full responsibility for my child(ren)'s participation. I for myself, my children and on behalf of my heirs, assigns, personal representative, and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS JMAD, their officers, officials, agents and/or employees, teachers, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and lessors of premises used to conduct activities, classes and/or events (RELEASEES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law arising from JMAD's activities. "Activities" include all in-house activities, as well as off-site activities, including, but not limited to nursing home shows, recitals, and rehearsals.
I've read the above and agree.
Electronic Signature 2024-2025
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I agree that my electronic signature will serve the same purpose as a written signature.
I've read the above and agree.
Enter your Full Name:
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