Adult Registration Form and Liability Waiver

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Date
Month
Day
Year
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Dancer Information* This field is required.
Name- FIRST , LAST
Birthdate -REQUIRED
Cell Phone
Address
City, Zip Code
E-mail/Parent Guardian E-mail
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Allergies or Health Concerns
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How did you hear about our studio?
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Emergency Contact Information
Contact Name
Relationship to Dancer
Cell Phone
Email Address
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LIABILITY RELEASEIndicated in the space below are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, herby waive and release En Pointe Dance & Fitness, individually and , En Pointe Inc. and its staff from any and all claims or damages of any kind arising out of my participation in the exercise and/or dance program of En Pointe Dance & Fitness. I certify that I am in proper physical condition to participate in the exercise/dance program and that I have been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do herby authorize En Pointe Dance & Fitness or her designated agents (being teachers or administrators employed by En Pointe Dance & Fitness.) to obtain medical treatment for myself in emergency situations if needed. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make release En Pointe Dance & Fitness responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below. Permission is granted to En Pointe Dance & Fitness to use photographs of myself or my child for publicity purposes. I have read, understood and agree to be bound by the above statement and have been given a copy of En Pointe Dance & Fitness Studio Policies and Dress Code ( please print your name, sign & date.)
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Studio Policies & Procedure Acknowledgment* This field is required.. ADULT PAYMENTS, POLICIES AND PROCEDURES CLASS SCHEDULE AND CANCELLATIONS: Adult Classes are available to purchase individually or in bulk packages. Class are available for use within the following time frame: Single Class: 30 Days 5 Class Pass: 3 Months 10 Class Pass: 6 Months 20 Class Pass: 12 Months Adult Class Size Policy: Classes with less than 2 students will be canceled. If you come to the studio for a class that has been canceled, your account will be credited for a complimentary class. Classes scheduled before 10:00AM must be registered for 12 hours in advance or they are subject to cancellation. No-Show/Late Cancel Policy: If you do not show for a registered class or fail to cancel your class or notify the studio that you will not be attending within 1 hour of the scheduled class time, your account will be subject to Forfeiture of enrolled class. APPROPRIATE DANCE ATTIRE FOR ADULT DANCE CLASSES BURN AT THE BARRE: Any fitted workout pants or sweats, a fitted tank top or t-shirt & bare feet. ADULT BALLET: Any Leotard & tights, ballet skirt, ballet shorts, stretch pants, yoga pants, or tank top and ballet shoes or socks. Hair should be pulled out of the face or in a bun. ADULT TAP: Any leotard & tights, jazz pants or shorts. Tap or jazz shoes. Hair should be pulled out of the face. CONTEMPORARY/ JAZZ/ LYRICAL: Any leotard & tights, tank top, jazz pants or shorts, dance top. Bare feet, or half sole shoes. Hair should be pulled out of the face. HIP-HOP: Athletic shorts or pants with a fitted dance top or t-shirt. Any tennis shoes are acceptable as long as they are not backless or open toed. **This is the only class in which street clothes are appropriate **NO BLACK OR COLORED SOLED SHOES**
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