IGNITE WEEK! Guest Registration Form

Parent's Name*

First NameLast Name

Child’s Name*

First NameLast Name

Age*

E-mail*

Phone Number*

Area CodePhone Number

School *

Gender*

MaleFemale

Please Select Class Level according to age*

Pre-Dance ( Ages 3-6)Level I ( Ages 7-9)Level II (Ages 10-12)Level III (Ages 13-18)

Please Select the Classes Attending.*

(AGE 10-12) - TUESDAY - 6:30PM-8:30PM BALLET & JAZZ(AGE 13-18) - WEDNESDAY - 6:30PM-8:30PM BALLET & JAZZ(AGES 7-9) FRIDAY 6:00PM-7:00PM HIP HOP 1(AGE 10- 12) - FRIDAY - 7:00PM- 8:00PM HIP HOP 2(AGE 13-18) - FRIDAY - 8:00PM-9:00PM HIP HOP 3(AGE 3.5-6) - SATURDAY -10:00AM- 11:30AM BALLET/TAP/HIP HOP(AGES 7-9) - SATURDAY -11:30AM-1:30PM- BALLET & JAZZ

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Allergies

Medical

Asthma

Behavioral

How did you hear about Elevé Dance Theater?*

Liability Waiver/ Photography Release

I understand and acknowledge that there is a risk of injury inherent in dance activities and that personal injury or damage to property may result during participation in dance and related activities. I represent that ____________________________(child) is physically able to safely participate in dance and related activities. I agree to assume all risks associated with my child’s participation in dance instruction, rehearsal, performance and related activities. In consideration of receiving dance instruction at Elevé Dance Theater, I hereby waive, release and discharge all present and future claims and liabilities of any kind, whether for bodily injury, property damage, or other loss, arising out of my child’s participation in dance and related activities, including but not limited to dance instruction, rehearsals, and performances, whether conducted on or off Elevé Dance Theater premises.I also acknowledge that I am responsible for delivering my child to the studio and picking her/him up and that the studio is not responsible for a child that leaves the premises.

If parent or Emergency Contact cannot be reached in case of an emergency, consent is given for my child to receive medical or surgical care as recommended by the physician or hospital.

I have read this release, understand it, and hereby agree to its terms. I also consent to photography and recording of my child for its usage in promotional and public relations activities. All recordings are property of Elevé Dance Theater.

I have received the Elevé Dance Theater Registration Form with the 2023-2024 Studio Calendar and agree to the terms regarding all related program fees and deadlines. I understand and agree to the withdrawal policy of a minimum of a 14 day written notification form as well as any changes to the dancer’s class schedule.

Name

First NameLast Name

Signature

Date

IGNITE WEEK! Guest Registration

Emergency Contact Information

Special Instructions/ Needs

Miscellaneous

Liability Waiver/ Photography Release