I`mPerfect Activity Room Classes

Name*

First NameLast Name

e-mail*

Primary Phone*

Area CodePhone Number

Work Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact (If Parent/Guardian cannot be reached)*

Relationship to Student*

Emergency Phone*

Area CodePhone Number

Same as Mailing Address

Billing Infomation differs from Parent/Guardian Information

Please note: Parent/Guardian listed above assumes primary responsibility for account maintenance. Billing Info is for contact information only.

Billing Name*

First NameLast Name

e-mail*

Primary Phone Number*

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Name*

First NameLast Name

Date of Birth*

MonthDayYear

Age

New or Returning Student?*

Returning StudentNew Student

Course Selection*

Colour Selection:

Total

Add Student 2?

Add Student 2

Student Name*

First NameLast Name

Date of Birth*

MonthDayYear

Age*

New or Returning Student?*

Returning StudentNew Student

Course Selection*

Colour Selection:

Total Cost

Add Student 3?

Add Student 3

Student Name*

First NameLast Name

Date of Birth*

MonthDayYear

Age*

New or Returning Student?*

Returning StudentNew Student

Course Selection*

Colour Selection:

Total Cost

SubTotal

Tax

Grand Total

Payment is required to secure a place in each class. Class sizes limited. Payment can be sent via e-transfer imperfectroom@gmail.com

Notes:

Today's Date

Date

WAIVER & RELEASE OF LIABILITY - THIS AGREEMENT CONTAINS A WAIVER & RELEASE OF LIABILITY AND INDEMNITY AGREEMENT TO WHICH YOU WILL BE BOUND, AND UNDER WHICH YOU WILL BE WAIVING IMPORTANT LEGAL RIGHTS. DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT.

Terms and Conditions:

By checking 'I Agree' below and submitting this form, you, the Participant and the Parent or Guardian of the above student(s), agree to release I'mPerfect Activity Room, including instructors and assistants from liability for any and all injuries which may occur while training, practicing, performing, or during any studio event or activity. You authorize the I'mPerfect Activity Room Staff to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the camper involved.You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your child(ren) at your expense should the need arise.

I contract on behalf of myself and my children/guest(s) and assigns, that the company and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me, or my children/guest(s) in, on, or about the premises, or as a result of the use of the equipment/tools/supplies/toys or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of the company.

I understand that I should seek the advice of my physician before commencing any exercise routine for both my self and my children/guests.

I assume any and all risks of injury associated with or in any manner related to my participation and/or my children’s/guests participation in and utilization of programs, workshops, seminars, classes, videos, and/or livestreams provided by the I`mPerfect Activity Room and its subcontractors.

I agree and covenant not to sue or otherwise attempt to hold the I`mPerfect Activity Room, its employees or the sub contractors of I`mPerfect Activity Room liable for any injuries regardless of the cause to either myself or my children.

I agree to indemnify and hold I`mPerfect Activity Room, its employees and its sub contractors harmless against any and all claims arising out of my participation as well as the participation of my children/guests in and utilization of the programs, workshops, seminars, classes, videos, and/or livestreams provided by I`mPerfect Activity Room and its employees and subcontractors.

I assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me or my children/guests, and I hereby fully and forever release and discharge the company, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights of action, or causes of action, present or future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment/supplies/tools/toys and facilities.

This waiver and release agreement is intended to be as broad as is allowed under the applicable law and applies to any and all claims for damages.

I understand and accept these guidelines*

I AgreeI Do Not Agree

The I'mPerfect Activity Room does not discriminate on the basis of race, color, sex, handicap, religion or national origin. The I’mPerfect Activity Room reserves the right at its sole discretion to refuse an application or dismiss a child from camp. No refund will be made of fees if the child has attended any portion of the program.

I understand and accept these guidelines*

I AgreeI Do Not Agree

I give The I’mPerfect Activity Room permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at The I’mPerfect Activity Room and can be used for promotional purposes without notification.

I understand and accept these guidelines*

I AgreeI Do Not Agree

Program fees are non refundable unless the I'mPerfect Activity Room is unable to provide classes for any reason. In the event we cannot provide the arranged classes/provide a makeup day you will be entitled to a full or partial refund. You will recieve a full refund if the I'mPerfect Activity Room cannot provide ANY classes for said scheduled program. You will be refunded for each day the I'mPerfect Activity Room cannot provide classes. Program spaces are however transferrable if you find someone else to take your spot. You may only transfer your program space if a. the course has not yet started AND b. you have not yet participated in any of that programs classes.

I understand and accept these guidelines*

I AgreeI Do Not Agree

Signature*

Studio Classes

Parent/Guardian Info

Billing Info

Participant / Student Info

Participant / Student 2 Info

Participant / Student 3 Info

Totals

Terms and Conditions