NMD+ Accelerate Winter 2024

NMD+ Accelerate Registration Winter 2024

Accelerate is an invite-only program where dancers will learn one minute of choreography from a guest each week for 6 weeks. The final dance work will be performed in the NMD2 show on February 18th at the MATCH in Houston. Please complete all information.
Participant Information
Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
Gender

MaleFemale
Participant Phone Number*
Please enter a valid phone number.
Participant Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School*
Name of Jr. High or High School
Grade Level*
Previous & Current Dance Training*
Emergency Contact Information

Please provide a contact whom we could reach in event of an emergency.
Name*

First NameLast Name
Relationship to Participant*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian Information

Required for students 18 years and younger.
Name

First NameLast Name
Relationship to Participant
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
NMD+ Directors communicate regularly via email. Please provide the email which you most regularly check.
NMD+ Accelerate Health Form

This form will help expedite the proper care if the participant has any medical emergency or care needs.
Do you currently have health insurance?*

YesNo
Health Insurance Company*
If you do not have health insurance, please write "N/A" and fill out the following:
Please complete only if you DO NOT have health insurance.
Due to the fact that we/I do not have medical insurance for Participant Name, we/I will assume all responsibility for payment(s) of medical treatment in the event that an injury occurs to the NMD+ Participant.
Signature First Name Last Name Date
Primary Physician Information
Primary Physician Name

First NameLast Name
Office Phone
Please enter a valid phone number.
Hospital Preference
Medical/Injury History
Medications
Please list any medicines the participant takes on a regular basis.
Medical History
List any reactions to medications the participant has had and when.
Physical Well-Being
Please list any physical or dance related problem the participant has such as an injury, bone, joint or muscular disorder.
Other Health Information
Please provide information about any psychological or emotional matters which could affect the participant’s physical health and about which our NMD staff should be aware.
Print Name/Guardian Name*

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Today's Date

Accelerate Dates will be on the Fridays listed below from 6-8pm.
January 19
January 26
February 2
February 9
February 16

All rehearsals are at Bonies Performing Arts Studio (the second location) the address is:
4545 Research Forest Suite A
The Woodlands, Texas 77381

Final Show: Sunday February 18th at the MATCH in Houston

Price: $395
NMD+ Accelerate Payment Options

Financial Terms of Membership
By selecting Accelerate Series you will be enrolled in Accelerate and invoiced within 1-2 days.

Accelerate Series
I agree that I have read and understood the tuition schedule above.
Print Name/Guardian Name Signature Date
For questions about payments or payment plans, please contact Lauren Serrano (lauren@noblemotiondance.com). Invoices for class cards will be emailed to you through NMD's PayPal account. All payments will be due a week from the invoice date.

Agreements
Initial Here* WITHDRAWALS: To withdraw a student, written notification MUST be submitted to NMD staff by email or in person. Withdrawals will result in a loss of nonrefundable deposit of $250.

Initial Here* REFUNDS: Refunds of tuition are allowed only for medical reasons, accompanied by doctor's note. The amount of refund will be based on a charge for each class conducted prior to the date the written notification is received. Reimbursement will take 4-6 weeks to process. No refunds will be issued for missed classes or withdrawals.

Initial Here*CLASS DATES AND TIMES:  6:00pm-8:00pm on January 19, January 26, February 2, February 9, February 16. Show on February 18th at The MATCH in Houston.

Initial Here* CLASS CANCELLATION: NMD reserves the right to cancel classes if needed. In the event of inclement weather, NMD reserves the right to not hold classes.

Initial Here* WAIVER OF LIABILITY: I, on behalf of myself and Student, and for Student’s executors and administrators, do hereby waive any and all claims, and indemnify, hold harmless and defend NMD, its directors, officers, agents, and employees from all liability, loss, or expense, including reasonable legal expenses, which may occur from any cause whatsoever during or arising from Student’s participation in classes, including any injury to Student or Student’s guests, or any damage, loss, or theft to Student’s property or Student’s guests’ property, except in cases of willful negligence or gross misconduct by NMD.

Initial Here* CERTIFICATION OF PHYSICAL CONDITION AND MEDICAL CONSENT: I, on behalf of Student, hereby certify that Student is reasonably suited to participate in dance classes and Student does not have any impairment that would adversely affect Student’s participation in the classes. I understand that NMD staff will attempt to contact me or the Emergency Contact should Student require medical attention while at NMD2 rehearsals/events. If I/we cannot be reached, I hereby authorize NMD staff to arrange for treatment as necessary.

Initial Here* FILM AND PHOTOGRAPHY RELEASE: I, on behalf of Student, agree to allow videography and photography of my child during rehearsals, dress rehearsals, and performances. These records will be both archival and promotional and for the sole use and benefit of NMD.

I confirm that I have read this form and agree to abide by the policies and procedures listed herein.

Print Name/Guardian Name*     Signature*   Date*
Should be Empty:

NMD+ Accelerate Registration Winter 2024

Participant Information

Emergency Contact Information

Parent/Guardian Information

NMD+ Accelerate Health Form

Primary Physician Information

Medical/Injury History

NMD+ Accelerate Payment Options

Agreements