JYSD 2020 Summer Class Registration

CHILD'S INFORMATION:

Child's Name*

First NameMiddle InitialLast Name

DOB*

MonthDayYear

Age*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

School Name by 9/2020*

Grade by 9/2020*

PARENT/GUARDIAN INFORMATION:

PARENT/GUARDIAN 1

Parent/Guardian*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Personal E-mail Address*

PARENT/GUARDIAN 2

Parent/Guardian

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone

Area CodePhone Number

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Personal E-mail Address

example@example.com

EMERGENCY CONTACT INFORMATION

Emergency Contact 1*

First NameLast NameRelationship to Child

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Emergency Contact 2*

First NameLast NameRelationship to Child

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

Cell Phone*

Area CodePhone Number

ALL OTHER PERSONS AUTHORIZED TO PICK UP YOUR CHILD FROM JYSD'S DANCE PROGRAM (IN ADDITION TO PARENT(S)/GUARDIAN(S) AND EMERGENCY CONTACT(S):

Person 1

First NameLast NameRelationship to Child

Person 2

First NameLast NameRelationship to Child

Person 3

First NameLast NameRelationship to Child

Person 4

First NameLast NameRelationship to Child

CHILD'S MEDICAL INFORMATION

Doctor's Name*

First NameLast Name

Doctor's Phone*

Area CodePhone Number

Medical Insurance Provider*

Policy Number*

Does your child have any allergies or intolerances to food, medications, etc.? If so, please provide details: *

Please provide information on any chronic physical problems and pertinent developmental information and any special accommodations needed:

Please upload medical documents, if necessary:

Browse Files

Will your child be required to take medication at JYSD? If so, please provide details:*

PARENT/GUARDIAN(S) STATEMENT OF UNDERSTANDING

The following information is important for the safety and protection of your child. Please read this information carefully, and sign below.

I understand that my child will not be released to any person(s) not listed on the registration form. Any person authorized to pick up my child must be listed on this registration form.
I understand that my child may not be left at Jasmin Yahné School of Dance (JYSD) program site unless a JYSD staff member or volunteer is there to receive and supervise my child.
I understand that JYSD is mandated to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.

I HAVE READ AND UNDERSTAND THE STATEMENTS ABOVE REGARDING THE SAFETY AND PROTECTION OF MY CHILD:

Parent/Guardian's Signature*

Date*

Date

PARENT(S)/GUARDIAN(S) STATEMENT OF AUTHORIZATION

In case your child becomes ill during the program, you will be contacted as soon as possible. In the event that the parent(s)/guardian(s) is not reachable the child’s emergency contact(s) will be notified. It is the responsibility of the parent(s)/guardian(s) to arrange for pick-up of your child from the program location.
I/we give authorization for the management and staff of JYSD to act for me according to their best judgment in the event of a medical emergency and/or routine medical care. I/we give permission for emergency medical treatment and/or routine medical care by the JYSD staff, a rescue squad, or private physician and/or hospital or emergency health care facility staff, under the same circumstances as above. If needed, any such action will be taken in the best interest of my child and will be reported to me/us as soon as possible. My signature waives or releases JYSD from any and all liability and/or financial responsibility for any medical expenses incurred.

BY SIGNING BELOW, YOU (PARENT(S)/GUARDIAN(S)) ARE AUTHORIZING ALL OF THE ABOVE ITEMS IN THE "STATEMENT OF AUTHORIZATION."

Parent/Guardian's Signature*

Date*

Date

JYSD 2020 REOPENING PLAN

2020 PARTICIPANT WAIVER FORM

BY SIGNING BELOW, I EXPRESSLY ACKNOWLEDGE AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REOPENING PLAN AND THE PARTICIPANT WAIVER FORM ABOVE.

Parent/Guardian's Name*

Parent/Guardian's Signature*

DateTime*

SUMMER 2020 FINANCIAL INFORMATION

BY SIGNING BELOW, I EXPRESSLY ACKNOWLEDGE AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE FINANCIAL INFORMATION FORM ABOVE.

Parent/Guardian's Name*

Parent/Guardian's Signature*

DateTime*

SUMMER 2020 COMMITMENT CONTRACT

Child's Name*

Parent/Guardian's Name*

Parent/Guardian's Signature*

DateTime*

SUMMER 2020 CLASS SCHEDULE

Choose Level*

Levels are based on dancer's age and experience. Beginner/Intermediate dancers will be taught on that level and may take classes with dancers one age level down. No dancer should be registered for an older age level, unless instructed by our director, Ms. Jasmin Yahné. Please be aware that instructors and Ms. Jasmin Yahné will make the final decision on student placement.

Class Selection*

Beginner/Intermediate Ballet (Ages 5-12)Intermediate/Advanced Ballet (Ages 11-17)Beginner/Intermediate Acro (Ages 5-12)Intermediate/Advanced Acro (Ages 11-17)Beginner/Intermediate Leaps & Turns (Ages 5-12)Intermediate/Advanced Leaps & Turns (Ages 11-17)Beginner/Intermediate Hip-Hop (Ages 5-12)Intermediate/Advanced Hip-Hop (Ages 11-17)

Class Packages/Fees*

4 for 4 (4 Weeks / 4 Classes) - $2404 for 3 (4 Weeks / 3 Classes) - $2004 for 2 (4 Weeks / 2 Classes) - $1504 for 1 (4 Weeks / 1 Class) - $80

2019-2020 DRESS CODE

2019 – 2020 DANCE SEASON
PARTICIPANT WAIVER FORM

ACKNOWLEGEMENT

                  I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the JYSD Dance Program, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, athletic activities, dance/sports programs/classes, the use of any equipment, exercise or other activities, or from my or my minor child’s or ward’s physical condition. I understand that JYSD and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns assume no responsibility for loss, damage, illness or injury to person or property that I or my minor child or ward, if applicable, may sustain as a result of my or their physical condition or resulting from my or their participation in any activities, programs, events, dance routines, classes, the use or non-use of any equipment, exercise, field trips, waterfront and pool activities, or any other challenge courses, or any other activities, classes, events, or programs at and/or sponsored by JYSD. I expressly acknowledge on behalf of myself and my minor child or ward, heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my or my minor child’s participation in any events/activities/programs/classes while at the JYSD Dance Program and/or sponsored by Jasmin Yahné School of Dance.

                  I also acknowledge that JYSD often uses photographs, videotapes, audiotapes, television programs, motion pictures, tape recordings, social media (i.e., JYSD website, Instagram, Facebook, Twitter, Snapchat) or other similar media for promotional purposes. I hereby consent to the use of my and/or my minor child’s or ward’s name and/or likeness in such material to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my and/or my minor child’s or ward’s name and/or likeness are an integral part of such photograph, videotape, television program, motion picture, tape recording, social media, or other similar media.

RELEASE

                  In consideration of JYSD allowing me and/or my minor child or ward to attend and/or participate in any programs, events, classes or other activities at JYSD and/or sponsored by JYSD, I hereby, for myself, my minor child or ward, heirs and executors, waive, release and forever discharge JYSD and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my attendance and/or participation in any such programs, events, classes and other activities, whether or not such loss, damage or injury results from the negligence of JYSD and its employees, agents, or representatives or from some other cause. My agreement to release JYSD does not include any loss, damage or injury that results from JYSD’s gross negligence or willful, wanton, or reckless misconduct.

                  I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording, social media or other use of my and/or my minor child’s or ward’s name and/or likeness, including any written article, script, caption or other writing that may accompany such use of my and/or my child’s or ward’s name(s). I hereby, for myself, my minor child or ward, heirs, and executors, waive, release and forever discharge JYSD and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my and/or my minor child’s or ward’s name and/or likeness in any such materials.

INDEMNIFICATION

                  I hereby represent and warrant to JYSD that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child or ward as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child or ward, or any other person nevertheless asserts any claim against JYSD arising out of me or my minor child’s or ward’s participation in any program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend JYSD from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of JYSD or from some other cause.

Payment Method:*

Credit CardMail a CheckIn-person at school

Payment*

Registration Fee$30.00

Total $0.00

JYSD Summer 2020 Class Registration

Registration Fee