TKA Performance Ensemble Registration

Student Name

First NameLast Name

Student Birthday

Date

Parent Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you want us to get in contact with you?

Previous Performing Arts Experience (Please include performances and studio(s).

What is your favorite thing about performing?

TKA Assumption of Risk Waiver: Waiver Text:ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT DECLARATIONS: This Agreement is entered into between The Kendrick Academy and the student, family of student, representative(s) of student. The provision of lessons by The Kendrick Academy and the Student, the Studentâ€™s use of any premises, facilities or equipment or any engagement during or related to the virtual sessions are contingent upon this Agreement. ASSUMPTION OF RISK: You agree that if you engage in any physical exercise or activity, including but not limited to dance training, or enter The Kendrick Academy Studio (all locations on site or off site including 122 E Main Street in Fort Valley, GA, or CMA Fitness in Warner Robins, GA located at 198 S Houston Lake Road, Warner Robins, GA, or Fort Valley Head Start, 700 Spruce Street, Fort Valley, GA, or Fort Valley Youth Center for Excellence, 500 Riley Ave, Fort Valley, GA) or use any facility or equipment on our premises or in your home related to virtual learning for any purpose, you do so at your own risk and assume the risk of any and all injury and/or damage you may suffer, whether while engaging in physical exercise or not. This includes injury or damage sustained while/or resulting from using any premises or facility, or using any equipment, whether provided to you or by The Kendrick Academy, or otherwise, including injures or damages arising out of the negligence of the Instructor, whether active or passive, or any of the Instructors, affiliates, employees, agents, representatives, successors, and assigns. Your assumption of risk includes, but is not limited to, your use of any exercise equipment (mechanical or otherwise), dressing areas, props, restrooms, sidewalks, parking lots, stairs, lobby or other general areas at The Kendrick Academy and/or related to The Kendrick Academy virtual learning. You assume the risk of your participation in any activity, class, program, instruction, or event, including but not limited to walking, jogging, running, aerobic activities, or dancing activities including spins, turning or jumping. You agree that you are voluntarily participating in the aforementioned activities and assume all risk of injury, illness, damage, or loss to you or your property that might result, including, without limitation, any loss or theft of any personal property, whether arising out of the negligence of the Instructor or otherwise. RELEASE: You agree on behalf of yourself (and all your personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge The Kendrick Academy, the Instructorâ€™s affiliates, related entities, employees, agents, representatives, successors and assigns from any and all claims or causes of action (known or unknown) arising out of the negligence of the Instructor, whether active or passive, or any of the Instructorâ€™s affiliates, employees, agents, representatives, successors, and assigns. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) your use or misuse of any equipment or facilities which may malfunction or break, (b) negligent instruction or supervision, including dance instruction or personal training, (d) negligent hiring or retention of employees, and/or slipping or tripping and falling while on any portion of The Kendrick Academy or while traveling to or from dance instruction, including injuries resulting from Instructorâ€™s or anyone elseâ€™s negligent virtual instruction. INDEMNIFICATION: By execution of this agreement, you hereby agree to indemnify and hold harmless The Kendrick Academy from any loss, liability, damage, or cost Instructor may incur due to the provision of instruction to you. ACKNOWLEDGEMENTS: You expressly agree that the foregoing release, waiver, assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by the law in the State of Georgia or whatever state the student resides or activity exist and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. You acknowledge that The Kendrick Academy offers a service to students encompassing the entire recreational and/or fitness spectrum. You acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability, express assumption of risk and indemnity agreement. You are aware and agree that by executing this waiver and release, you are giving up your right to bring a legal action or assert a claim against The Kendrick Academy for negligence, or for any defective product used while receiving instruction or using the facilities. You have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

Medical Emergency Waiver: In the event of a medical emergency, staff may call 911 if merited. Parents will be notified immediately and measures will be taken based on the advisement of medical professionals.

Release of Liability Waiver: DECLARATIONS: This Agreement is entered into between The Kendrick Academy and the student, family of student, and any representative. The provision of lessons by The Kendrick Academy and the Student, the Studentâ€™s use of any premises, facilities or equipment or any engagement during or related to the virtual sessions are contingent upon this Agreement. ASSUMPTION OF RISK: You agree that if you engage in any physical exercise or activity, including but not limited to dance training, or enter The Kendrick Academy Studio (all locations on site or off site including 122 E Main Street in Fort Valley, GA, or CMA Fitness in Warner Robins, GA located at 198 S Houston Lake Road, Warner Robins, GA, or Fort Valley Head Start, 700 Spruce Street, Fort Valley, GA, or Fort Valley Youth Center for Excellence, 500 Riley Ave, Fort Valley, GA or use any facility or equipment on our premises or in your home related to virtual learning for any purpose, you do so at your own risk and assume the risk of any and all injury and/or damage you may suffer, whether while engaging in physical exercise or not. This includes injury or damage sustained while/or resulting from using any premises or facility, or using any equipment, whether provided to you or by The Kendrick Academy, or otherwise, including injures or damages arising out of the negligence of the Instructor, whether active or passive, or any of the Instructors, affiliates, employees, agents, representatives, successors, and assigns. Your assumption of risk includes, but is not limited to, your use of any exercise equipment (mechanical or otherwise), dressing areas, props, restrooms, sidewalks, parking lots, stairs, lobby or other general areas at The Kendrick Academy and/or related to The Kendrick Academy virtual learning. You assume the risk of your participation in any activity, class, program, instruction, or event, including but not limited to walking, jogging, running, aerobic activities, or dancing activities including spins, turning or jumping. You agree that you are voluntarily participating in the aforementioned activities and assume all risk of injury, illness, damage, or loss to you or your property that might result, including, without limitation, any loss or theft of any personal property, whether arising out of the negligence of the Instructor or otherwise.

Photo/Video Release Waiver: I understand and agree that all photos and video taken of my child(ren) will become the property of The Kendrick Academy. I grant permission to The Kendrick Academy to use the photo and/or video of my child(ren) in its publications, newsletters, and social media. I release The Kendrick Academy from any claims that may arise from the use of photos. and video. I acknowledge and confirm that my student's photo and/or video can be used in The Kendrick Academy's print, electronic, and social media. I have read and understood the terms set forth in this release waiver.