Summer 4-week Program

Registration Form
This is a 4-week dance program held on Wednesdays from July 9th to July 30th, with sessions on July 9th, 16th, 23rd, and 30th. The cost is $85 for one dance style or $110 for two dance styles.
Dancer's Information
Dancer's Name

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Does the dancer have any allergies, chronic illness, or medical conditions? If yes, please describe.
Please select the class time for your child's registration:

Ages 1.5-3 Movement (5:30-6:15PM)Ages 3-5 Hip-Hop (6:15-7:00PM)Ages 3-5 Ballet (7:00-7:45PM)Ages 6-9 Hip-Hop (6:15-7:00PM)Ages 6-9 Acro (7:00-7:45PM)
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by The Dancelete Academy during the selected program. In exchange for the acceptance of said child’s candidacy by The Dancelete Academy ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Dancelete Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against The Dancelete Academy including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including dance. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I hereby give permission for my child to be photographed and/or videotaped during dance classes, performances, and events. I understand that these images may be used for promotional purposes, including but not limited to social media, websites, brochures, and other marketing materials. I consent to the use of my child's image without compensation or further approval required.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Registration Form