One Step At A Time Application Form
Hello, welcome to One Step At A Time! This application form will help us get to know you better before the start of the program and confirm your spot! There are no wrong or right answers, please answer honestly.
Student Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-Shirt Size (Adult Size)
*
Please Select
XS
S
M
L
XL
Do you have any dance experience?
*
Yes
No
If yes, how much experience do you have?
I have never taken a dance class.
1
2
3
4
5
6
7
8
9
I have danced for years.
10
1 is I have never taken a dance class., 10 is I have danced for years.
Do you have any coding experience?
*
Yes
No
If yes, how much experience do you have?
I have never coded before.
1
2
3
4
5
6
7
8
9
I have been coding for years.
10
1 is I have never coded before., 10 is I have been coding for years.
Why did you decide to join One Step At A Time?
*
I want to try something new.
A teacher or parent suggested that I participate.
I love to dance.
My friends are joining.
I love STEM/coding.
Other
What are two words you would use to describe yourself?
*
Will you be able to stay the duration of the program? (August 2nd - August 6th, 2021)
*
Yes
No
Anything else you want us to know?
Emergency Contact Information
First & Last Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact's Relationship to Student
*
Please Select
Mother
Father
Guardian (other)
Liability Release Form
I understand that participation in One Step At A Time could include actions or tasks which may lead to injury to the participant named above. By signing below, I assume any risk of harm or injury which might occur to the participant due to her participation in the activity. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold One Step At A Time, its owners, assistants, employees, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.
*
Yes
Photo/Video Consent
I give permission for my child to be photographed and video filmed. Footage will only be used by One Step At A Time for promotional and/or educational purposes.I acknowledge that I will not receive any compensation, etc. for the use of such pictures and footage. I understand that this footage will be made available to students and parents.
*
Yes
I hereby confirm that all of the above information is true, complete, and accurate.
Parent's Signature
*
Date
*
-
Month
-
Day
Year
Date
Participant's Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Form
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