Zerkalo Studio Dance Class A Registration Form

Zerkalo Studio Dance Class Registration for 7-12 years old:

Регистрация на классы танцевальной группы для 7-12 лет.
Имя и Фамилия ребенка/студента (на русском):*

ИмяФамилия
Full Name (In English)

First NameLast Name
Дата рождения:*

MonthDayYear
Date of Birth
Пол:*
Gender
Имя и Фамилия родителя (Parent's Full Name):*

ИмяФамилия
Телефон для связи:*
Please enter a valid phone number.
Имя и Фамилия второго родителя (Parent's Full Name)

First NameLast Name
Телефон для связи:
Please enter a valid phone number.
Email для связи:*
example@example.com
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LIABILITY WAIVER

By submitting this form, the undersigned hereby releases and forever discharges Zerkalo Musical Theater (dba Zerkalo, LLC) along with all of its agents, employees, directors, assigns and attorneys, from any and all claims, demands, actions, causes of actions and suits, arising out of any injuries, known and unknown, which have resulted or may in the future result from any Zerkalo Musical Theater (dba Zerkalo LLC) sponsored activity or event.

By submitting the registration form, the undersigned hereby assumes all risk of injury associated with any theater activity or event and fully indemnifies and holds harmless Zerkalo Musical Theater (doing business as Zerkalo LLC) along with all of its agents, employees, directors, assigns and attorneys from and against each and every liability, loss, cost, damage and expense, including attorney’s fees, which Zerkalo Musical Theater (Zerkalo LLC) along with all of its agents, employees, directors, assigns and attorneys may incur as a result of any Zerkalo Musical Theater (Zerkalo LLC) sponsored activity or event.

PHOTOGRAPHING AND FILMING STUDENTS

By submitting this registration form, the undersigned hereby gives consent for the following:

Collection, use and disclosure of your child’s photos, video, film and digital images that may be taken by the theater from time to time;
Recording theater performances, theater activities and events by other vendors/parents/guardians and students.
Parent/Guardian Name: First Name* Last Name*
Should be Empty:

Zerkalo Studio Dance Class Registration for 7-12 years old: