Students Name: _________________________________ Birth Date:______________
Parents Name: ____________________________________________________________
E-mail Address: ___________________________________________________________
Address: _________________________________________ City: __________________
Zip Code: ________________ Home Phone #: ________________ Cell #:___________
Dr. Name and Phone Number: _______________________________________________
Medical Allergies / Information: _______________________________________________
How did you hear about Ballare Dance Centre? __________________________________
Does your child have any dance experience? _________________
If so, where and how long ___________________________________________________
Registration Date: _____________________
Parent Signature: __________________________________________ Date:_________
I have read and fully understand the below release/ waiver and fully understand that I have give up substantial rights by signing the waiver voluntarily. I do hereby assume full responsibility for any and all dangers, injuries (including death), or losses that my child may sustain or incur, if any, while attending, practicing, participating or witnessing any dance program, sport or physical activity occurring in or about the studio premises or at any off site location. I hereby assume full risk, waive all claims and release and hold Ballare Dance Centre, its staff, or partners of said program or event, individually or otherwise, harmless for any and all claims for injury or damage.
I am fully aware and understand that the club/ studio does not have on or about the dance studio premises, or employ or contract with medical services, provisions for ordinary or emergency medical services. In consideration of my child’s participation in and the use of the studio’s facilities, I hereby release and covenant not to sue the studio, its owners, shareholders, directors, officers, employees, representatives, agents, and lessees from any and all claims resulting from physical injury that may occur to my child while participating in any program or event sponsored by Ballare Dance Centre.
Photo Release: Parents Please Initial For Acceptance
__________ I authorize Ballare Dance Centre to use any photo’s and or video’s taken of my child dancing with Ballare Dance Centre. Photos and or video of dancers will be used for marketing and promotional purposes. Photos and or videos of your dancer in the dance studio, during our dance recital and or at any Ballare Dance Centre sponsored event might appear on our Facebook and Instagram pages and or our Ballare Dance Centre website.