DRD Class Registration2

Dallas Rhythm Dance / New Student Registration

Have you registered with us this year?

YESNO

Name*

First NameLast Name

Where are you from?*

Street Address Line 2

CityState / Province

Zip

Phone*

Email Address*

example@example.com

Date of Birth (MM/DD/YYYY)*

Date

Congregation*

Elder Name*

Elder Phone Number*

How did you hear about us?*

Emergency Contact*

Relationship*

Phone Number*

Salsa On2 Classes*

Foundation 1Foundation 2 (Starting June4th)

Have you completed Foundations 1 Class?

YesNo

It is recommended to complete the Foundations 1 Class. Not doing so MAY result in not being able to follow class and be lost in our shines or partner work. Foundations 1 and 2 are essential in your dancing journey. If you feel you are ready for part 2, you can request a instructor session to make sure you have the basics from part 1 down and are good to move on to part 2

Start with Foundations 1 classRequest instructors sessionI understand the recommendation and will take my chance and start with Foundations 2

18 years old or under NEED LEGAL GUARDIAN SIGNATURE BELOW

1. In consideration of being allowed to participate in the dance program, do hereby forever waive, release and discharge Dallas Rhythm Dance, Dallas Can Dance Studios, Abel Camargo and their agents, employees, representatives, executors and all others acting on their behalf from any and all claims or liabilities for injuries or damages to my person (or child) and/or property, including those caused by the negligent act or omission of any of those mentioned or others acting their behalf, arising out of or connected with my participation in any activities, programs or services of Dallas Rhythm Dance and Abel Camargo.

2.I have been informed of, understand and am aware that any dance program, whether or not requiring the use of exercise/dance equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise/dance activity involve a risk of injury and that (my child) am/is voluntarily participating in these activities. I understand there are dangers involved. I hereby agree to expressly assume and accept any and all risk of injury and release Dallas Rhythm Dance and their agents, employees, representatives, executors and all others acting on their behalf.

3. I release, waive, discharge and covenant not to sue the dance facility used by Dallas Rhythm Dance and/or their agents, employees, representatives, executors and all others acting on their behalf.

4.I understand that through the teaching sessions, Dallas Rhythm Dance and their agents, employees representatives, executors and all others acting on their behalf may take pictures and/or video of class sessions, performances, socials and any other activities related to the dance program. Furthermore, understand these media images may be displayed on the social media, promotional posters and brochures. My signature indicates my permission to have photo and/or video taken of me (my child) and appear in the printed materials mentioned above.

5. I am an active, baptized Jehovah's Witness in good standing.

Student Signature*

Legal Guardian Signature (if the student is a minor)