Registration Form

Waiver(s)
Photo Release

PHOTO RELEASE

I understand that, I, as a program participant, may be
photographed for purposes of publication, and I hereby authorize PHOENIX DANCE36 LTD.CO., to
publish photographs of our names and likenesses, for use in its printed and online publications
(such as newsletters, annual reports, websites, social media and blog posts). I, in both an
individual and representative capacity, hereby release PHOENIX DANCE36 LTD. CO., its Board of
Commissioners, its officials, employees, agents, representatives and volunteers, and any third
parties involved in the creation or publication of printed and online publications (such as
newsletters, annual reports, websites, social media and blog posts) from liability for any claims
by me or any third party in connection with my participation 

WAIVER/RELEASE

1. In the event of illness or injury, I hereby authorize the PHOENIX DANCE36 LTD. CO., to notify 911, fire/paramedics or any deemed necessary medical/legal/police authority 
and I hereby assume the cost of such treatment/transport/notification.  
2. To my knowledge, I do not have any medical or other condition which would prevent me, from participating in the program/activity. I also acknowledge that if I
have any reservations or concerns about my, medical condition, it is
my responsibility to consult with the appropriate medical personnel prior to participating
in the program/activity.
3. I am providing this authorization in advance of any specific diagnosis, treatment, or
hospital care being required but is given to provide authority and power on the part of
PHOENIX DANCE36 LTD. CO. to give specific consent to the diagnosis, treatment, or hospital care which in
the best judgment of a licensed physician is deemed advisable. I understand that every
effort will be made to notify the individual indicated as the emergency contact beforehand
by telephone.
4. I acknowledge, acceptance of this release is not to be construed as an admission of any
liability whatsoever by PHOENIX DANCE36, LTD.CO.  and/or any of its officers, agents, and
employees. This release and hold harmless agreement shall constitute full and complete
release of any and all claims.
I, the undersigned, have carefully read the foregoing release and know and understand the
contents thereof. I sign this release voluntarily as my own free act, with full knowledge of it
significance, intending to be legally bound thereby.

Agreed to bY SIGNED PARTICIPANT BELOW:

Hold Harmless

Waiver Of Liability and Hold Harmless Agreement

For and in consideration of my participation in any PHOENIX DANCE36 LTD.CO. program or activity I do
hereby enter into the following covenant:
I do hereby agree not to sue PHOENIX DANCE36 LTD.CO. & their officers, agents, employees, or
assignees for any reason arising from my participation in such activity.
This covenant not to sue shall be binding upon myself, my heirs, the administrator or executor of
my estate or upon any others acting on behalf of myself or my estate. It is expressly understood
that this covenant not to sue is entered into for the purpose of avoiding litigation and is a
prerequisite to my participation in such activities. This covenant to sue shall be a defense to any
action or proceeding which I may bring, or which may be brought, instituted, or taken by my
heirs, the executors or administrators of my estate, or any others on my behalf of my estate,
against any of the parties listed in the first portion of this document.
I expressly assume all risks and hazards associated with the activities and assume all
responsibility, including but not limited to financial responsibility, for any injury, including death,
that I may receive while in, or upon the premises where the activities are being conducted.
This covenant not to sue covers, but is not limited to acts of negligence, either by commission or

omission, of any type, kind or nature whatsoever.
I hereby state that I am under no disability to contract and have read and understand this
covenant not to sue and have entered into it voluntarily.
Agreed to by SIGNED PARTICPANT BELOW: 

Thank you for registering with PHOENIX DANCE36 LTD.CO!

Please review the below sections for payment submission info and refund policy. 

NO REFUNDS WILL BE ISSUED FOR CLASSES & EVENTS. In the event of class or event cancellation, a reschedule date will be given to notify all participants via email or text. 

PHOENIX DANCE36 LTD.CO. & Treserves the right to dismiss any participant(s) who engage in disruptive, violent, and/or unsafe and dangerous behavior that may jeopardize the safety of class particpants and instructor(s). In addition, appropriate authorities may be notified. 

PHOENIX DANCE36 patrons are subject to video surveillance.

Warning

Any person entering the premises at 3217 NEW MACLAND RD. STE 40 POWDER SPRINGS, GA waives all civil liability against this premises, and PHOENIX DANCE36 LTD.CO. owners and operators for any injuries caused by the inherent risk associated
with contracting COVID-19 at public gatherings, except for gross negligence,
willful and wanton misconduct, reckless infliction of harm, or intentional
infliction of harm, by the individual or entity of the premises.

PAYMENTS

1. I agree to execute payment(s) immediately after completing this registration form to secure and ensure my registration is complete. I understand that forms submitted without following payment do not constitute a completed registration and does not guarantee my registration for classes and or/events. 

2. I AGREE TO ISSUE PAYMENT VIA THE FOLLOWING OPTIONS: please leave your name, quantity and type of  classes registering for. 

▪️ZELLE: SEND PAYMENTS TO:

(678) 531-5802 (Phoenix Ltdco)

In the Note section: please leave your name and total classes registering for. 

▪️CASHAPP: $RogueStarPhoenix (In the note Section: please leave your name and total classes registering for.)

  If you would like to pay in cash, PLEASE BRING EXACT CHANGE. 

ALL CARD PAYMENTS MAY BE PROCESSED SECURELY IN PERSON OR ON THIS FORM IN THE ABOVE FIELD WHERE CLASSES ARE LISTED.