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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Release of Liability
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I understand and agree that in participating in any dance class, lesson, workshop, rehearsal, and/or performance there is a possibility of physical injury and, in rare circumstances, death. This is true for classes, lessons, workshops, rehearsals, and/or performances. In addition, I understand that I should be aware of mine and/or my child's physical limitations and agree not to exceed them. I further acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected by COVID-19 by attending in-person dance classes, private lessons, rehearsals, and/or performances. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury and/or illness to myself and/or my child. I agree to release and hold harmless Center Stage Dance Studio, including its owners, agents, teachers, dancers, staff members, and facilities (Collectively referred to as "Center Stage Dance Studio") from any cause of action, claims, or demands now and in the future. I will not hold Center Stage Dance Studio liable for any personal injury, personal illness, and/or any personal property damage which may occur on the premises and/or during a class, private lesson, rehearsal, and/or performance conducted on behalf of Center Stage Dance Studio. This is also true for all potential COVID-19 risks, illnesses, and possible exposure.
I've read the above and agree.
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Medical Emergency
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I hereby authorize Center Stage Dance Studio, its owners, and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health.
I've read the above and agree.
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Photo/Video Release
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I hereby authorize Center Stage Dance Studio and its owner, agents, teachers, dancers, and staff members to take and use photographs and videos of myself and/or my child for purposes of recording, teaching, advertising, marketing, its website, and/or all social media platforms.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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