Mommy and Me Sign up Form

Parent Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Baby's Name*

First NameLast Name

Baby's Date of Birth*

Date

Baby Prince or Baby Princess*

PrincePrincess

Name and relationship of the Adult attending the class with the baby (Mom, dad, grandparent, caretaker)

Mommy & Me Sessions - Wednesdays from 4:30 - 5:15PM*

Do you have an active Mommy and Mession 4-session card?*

YesNo

Note: If you do not have a valid Mommy and Me Card, an invoice will be sent and payment must be completed prior to class.

ASSUMPTION OF RISK AND LIABILITY AGREEMENT:

I hereby state that my child is in good mental and physical health condition to participate in all Mommy and Me activities and classes. I hereby release Feijoo Ballet School from any and all liability, claims, suits, demands, judgments, costs, interest, and expenses (including attorney fees and costs) arising from, or related to, such activities and/or any related activities, including any accident or injury to the student and the costs of medical services. I also agree not to hold these parties responsible in the event that myself/son/daughter engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior.

I/we understand that Mommy and Me sessions at Feijoo Ballet School requires a sustained, repetitive physical activity, usually performed on a hard or lightly-padded surface without protective footwear (i.e., athletic shoes). It is also understood that sessions may involve kinetic corrections that may include physically touching and manipulating the body of the participant as part of the program. I/we understand that participants engage in a broad range of quick movements, bending, twisting, running, leaping and lifting, which place demands on the human body, including movement of joints and ligaments, repetitive impact, and occasional falls, slips and collisions with other participants and objects. I/we also understand that Feijoo Ballet School is not staffed to monitor and supervise the activities of its participants at all times, and that the tuition schedule does not contemplate constant supervision. All participants must alwsy be accompaniued by a responsible adult while at Feijoo Ballet School's facilities. I/we also understand that there are inherent risks of serious personal injury involved in all of the above activities. I/we voluntarily assume and accept such risks of personal injury and illnesses arising from my/our child’s attendance and participation in such activities. I/we hereby release Feijoo Ballet School, its Board of Directors, staff, agents, and guests, as well as all facilities where Feijoo Ballet School is training and their Board of Directors, staff, and guests from all actions, claims or demands that I/we, my/our child, our heirs or representatives now have or may hereafter have for personal injuries or property damage resulting from my/our child’s attendance at and/or participation in any Feijoo Ballet School activities and events. I/we agree that this release includes personal injury or property damages caused in whole or in part by negligence, active or passive, of Feijoo Ballet School, its trustees, staff, agents, and guests. This release does not apply to liability for willful injury or fraud. This permission and release shall remain effective through the end of the Feijoo Ballet School program, unless and until a written revocation is delivered to Feijoo Ballet School Director.

I further attest that the information in this form is correct to the best of my knowledge. I hereby allow myself/child to be photographed and videotaped at Feijoo Ballet School for the purposes of the studio’s promotional material and publications.

I Agree to the above statement

Mommy and Me Session Sign Up