2026-27 Fall Registration Form

Dancer 1 Name

First NameLast Name

Dancer 1 Birth Date

MonthDayYear

Dancer 1 grade in school

Dancer 1 Age

Dancer 1 Allergies (if none put none)

Dancer 1 School

Dancer 1 Classes. Select all that apply. Please note class ages are grouped based on grade in school and/or age as of September 1st.

Dancer 2 Name (if applicable)

First NameLast Name

Dancer 2 Birth Date (if applicable)

MonthDayYear

Dancer 2 grade in school

Dancer 2 Age (if applicable)

Dancer 2 Allergies (if applicable)

Dancer 2 School (if applicable)

Dancer 2 Classes. Select all that apply. Please note class ages are grouped based on grade in school and/or age as of September 1st.

Dancer 3 Name (if applicable)

First NameLast Name

Dancer 3 Birth Date (if applicable)

MonthDayYear

Dancer 3 grade in school

Dancer 3 Age (if applicable)

Dancer 3 Allergies (if applicable)

Dancer 3 School (if applicable)

Dancer 3 Classes. Select all that apply. Please note class ages are grouped based on grade in school and/or age as of September 1st.

Parent Name

First NameLast Name

Phone Number

Area CodePhone Number

Secondary Phone Number (if needed)

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent Email

example@example.com

Secondary Email (if needed)

example@example.com

How did you hear about us

If referred by a friend, please put their name here!

I understand that recital costumes are ordered according to sizing charts provided by costume companies. Due to allowing for growth, if your child is on the edge of the size chart, we will push them up to the next size. I, the parent, understand that HRDS will not be responsible for alterations that I think are necessary if the costume is too large in some areas. I understand that HRDS will only be responsible for exchanges or alterations if my child is unable to fit in a size ordered due to a recent growth spurt (i.e. the costume is deemed by HRDS to be too small).

I understand that the registration fee paid at this time is non refundable and the August tuition is only refundable until classes start on August 24. I also understand that the registration fee includes the recital video and 2 recital tickets per family, not per dancer.

I understand that classes fill quickly, and as much as HRDS staff updates listings there is the possibility of class availability changing during online registration. In the instance that the classes registered for have already filled, HRDS staff will contact you within 24 hours for additional class options. If class replacements cannot be found a refund will be issued via paypal.

Number of Classes - includes registration fee which includes 2 recital tickets and the recital video (totaled by family)

Certification of Authority: I, understand, hereby certify that I am the Parent or Legal Guardian of the Participant(s) for whom I am completing this Liability Waiver & Release form.

Informed Consent: I hereby give my consent for the named Participant(s) in this registration to participate in any and all Heavenly Rhythm Dance Studio activities. I understand dancing, and acrobatics carry a risk of physical injury. I fully understand these risks and agree not to hold Heavenly Rhythm Dance Studio or its staff responsible for any form of injury that may occur during activities at Heavenly Rhythm Dance Studio. I hereby waive, release, absolve, and indemnify the Heavenly Rhythm Dance Studio program, coaches, staff and the premises owners on which any of its activities may be held, for any claim.

Hold Harmless: I, on behalf of myself and the Participant(s) for whom I am completing this Liability Waiver & Release, release and hold harmless Heavenly Rhythm Dance Studio, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of related to any loss, damage, or injury that may be sustained by Participant(s).

Media Release: I give my permission for any photo or video of the Participant(s) for whom I am completing this Liability Waiver & Release (e.g., my child) taken while on the premises or in dance class at Heavenly Rhythm Dance Studio, or Heavenly Rhythm Dance Studio sponsored event, to be used for advertisement or promotion on the Heavenly Rhythm Dance Studio website or other social medias. (Note: dancer identity will not be released).

Infectious Diseases: By the signing of this Liability Waiver & Release, the undersigned acknowledges the contagious nature of COVID-19 and other infectious diseases, and voluntarily assumes the risk that they, and any Participant(s) for whom they are completing this Liability Waiver & Release form, may be exposed to or infected by COVID-19 or other infectious diseases by use of the property, facilities, services, and/or programs of Heavenly Rhythm Dance Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned understands that the risk of becoming exposed to or infected by COVID-19 or other infectious diseases at, or on the premises of, Heavenly Rhythm Dance Studio may result from the actions, omissions, or negligence of themselves and others, including, but not limited to, Heavenly Rhythm Dance Studio and its staff, program participants and their families; and I acknowledge and agree that I am releasing and holding harmless Heavenly Rhythm Dance Studio and its owners and operators with respect thereto pursuant to the “Hold Harmless” section of this Liability Waiver & Release. I affirm my responsibility to immediately notify Heavenly Rhythm Dance Studio in the event of any known exposure of myself, and/or any Participant(s) for whom I am completing this Liability Waiver & Release Form to someone who has a positive or presumed positive (waiting for results) COVID-19 test in the last 14 days. I hereby agree, on behalf of myself and the Participant(s) for whom I am completing this Liability Waiver & Release, to ensure that myself, any such Participant(s) and any spectators known by me to be entering the premises of Heavenly Rhythm Dance Studio, or any Heavenly Rhythm Dance Studio event held at other locations, have not knowingly been exposed to someone who has a positive or presumed positive (waiting for results) COVID-19 test in the last 14 days, and are not experiencing any shortness of breath, fever, cough, sore throat, loss of taste or smell, chills, head or muscle aches, nausea, diarrhea or vomiting.

Electronic Signature: I consent to have my electronic signature on this document treated as a full and complete, legally binding signature.

Signature

OFFICE USE ONLY:

___ Quickbook customer ___ Add to Reg ___ Add to Roster ___ Add to email group

___ Welcome email ___Add to Attendance ___ Add/change invoice

2026-27 Fall Registration Form

Number of Classes - includes registration fee which includes 2 recital tickets and the recital video (totaled by family)*

Number of Classes - includes registration fee which includes 2 recital tickets and the recital video (totaled by family)