TDS Registration Form

Are you a new student?

YesNo

Parent or Guardian*

First NameLast Name

Student's Name*

First NameLast Name

Age and Birthdate*

AgeBIrthdate : 11-20-2010

Parent or Guardian Phone Number*

Please enter a valid phone number.

Parent or Guardian Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Can we text you?*

YesNo

Auburn Studio. Please check the box.

Tap_________________________________Acro_________________________________Jazz-Hip Hop Fusion____________________________Dance 101 (ages 2 & 3)_________________________________Lyrical / Contemporary_________________________________Prepointe (instructor approval required)_______________________________Pointe (instructor approval required)___________________________________Leaps & Turns (instructor approval required)______________________________

C level ballet at the Auburn studio is filled. There are openings for the C level ballet at the Garrett Studio on Thursdays from 6:30-7:15.

Garrett Studio. Please check the box.

Tap________________________________Ballet_______________________________Jazz-Hip Hop Fusion_______________________Acro________________________________Dance 101 (ages 2 & 3)_________________________________Lyrical / Contemporary________________________________

Tell us the number of years of experience your child has and where they acquired their dance and or acro education.*

Does your child have any medical condition that we need to be aware of?*

How did you hear about us?*

FacebookA FriendInternetBanner

If someone referred you we would like to know.

To confirm your registration a fee is $20 is required.*

I acknowledge that I will pay a $20 registration fee

Promotional Code

TDS Waiver

Please initial each box.

Disclaimer. TDS-The Dance Studio staff reserves the right to remove any person (or persons) who present potential harm, danger or disruption to themselves or anyone around them while attending events or lessons.*

Liability Release. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I agree to release and to hold harmless that TDS-The Dance Studio event and/or lessons, the facility on whose premises, and the respective directors, officers, representatives, members, agents and employees of TDS-The Dance Studio and the location and their respective affiliates (here in after collectively “Releasees”) from any and all liability, whether based on negligence, contract, tort, statute or otherwise, for any claim, judgment,loss, liability, cost and expenses (including, without limitations, attorney’s fees and cost) arising out of or connected with TDS-The Dance Studio event and/or lessons I and/or participant attending, including but not limited to any claim arising out of or connected with any illness or injury (minimal, serious,catastrophic and/or death) that I and/or participant may incur or sustain during any event or lessons, all activities associated with TDS –The Dance Studio and while traveling to and from the site for any event and/or lessons whether or not the event and/or lessons actually occurs. I and/or participant further expressly agree to indemnify and hold harmless Releasees and Releaseesheirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may subsequently be brought by me or by any other persons on the account of damages of any characters resulting to me in any way from the foregoing activities. I and/or participants further agree to reimburse and to make good to Releasees any loss, damages, or cost Releasees may have to pay as a result of any such action, claim, or demand, including but not limited to attorney’s fees.*

Medical Release. I and/or participant acknowledge and agree that participation in any event and/or lessons subjects I and/or participant to the risk of physical illness or injury(minimal, serious, catastrophic and/or death) and that I and/or participant acknowledge that I am assuming the risk of such illness or injury by participating in the event and/or lessons. In the event of such illness or injury, I and/or participant authorize TDS-The Dance Studio to obtain necessary medical treatment for me and hereby release and hold harmless Releasees in the exercise of this authority. I further acknowledge and understand that I and/or participant will be responsible for any and all medical and related bills that may be incurred by me for any illness or injury that I and/or participant may sustain during any event and/or lessons and while traveling to and from the site for any event and/or lessons whether or not the event and/or lessons actually occurs.*

Photo Release. I give permission to have photos and video of me and/or participant to be published for the advertisement and promotional uses of TDS-The Dance Studio.*

I hereby warrant that I have read this Liability Release Form in its entirety and fully understand it contents. I and/or participants am aware that this Liability Release Form releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I and/or participant further acknowledge that nothing in this Liability Release Form constitutes a guarantee that the event and/or lessons will occur. I have signed this document voluntarily and of my own free will.*

Signature*

Non Refundable Registration Fee

Registration

$20.00

Total

$0.00