Heavenly Rhythm Dance Studio Saturday Mini Session Registration

Heavenly Rhythm Dance Studio Saturday Mini Session Registration

We will be holding Saturday mini sessions in the Winter. Classes will run Saturday mornings from Jan 4 - Feb 1
Dancer 1 Name*

First NameLast Name
Dancer 1 Age*
Dancer 1 Birth Date*

MonthDayYear
Dancer 1 Allergies (if none put none)*
Dancer 1 School*
Dancer 1 Classes. Select all that apply. Please note class ages are determined as of the class start date*
Dancer 2 Name (if applicable)

First NameLast Name
Dancer 2 Age (if applicable)
Dancer 2 Birth Date

MonthDayYear
Dancer 2 Allergies (if applicable)
Dancer 2 Classes. Select all that apply. Please note class ages are determined as of the class start date.
Parent Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Secondary Phone Number (if needed)

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email*
example@example.com
Secondary Email (if needed)
example@example.com
How did you hear about us*
For mini sessions, classes occasionally get split into groups to allow the most quality classes. If you have a request to be with another dancer, please put their name here.
Please select the appropriate payment option. Mini Sessions are priced per child, not per family. *
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One Child, One Class (One Session)$79.00

Two Children, One Class Each (One Sessions Each)$158.00

Total $0.00
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The payment is ready! It will be completed once you submit the form.
Certification of Authority: I, understand, hereby certify that I am the Parent or Legal Guardian of the Participant(s) for whom I am completing this Liability Waiver & Release form.

Informed Consent: I hereby give my consent for the named Participant(s) in this registration to participate in any and all Heavenly Rhythm Dance Studio activities. I understand dancing, and acrobatics carry a risk of physical injury. I fully understand these risks and agree not to hold Heavenly Rhythm Dance Studio or its staff responsible for any form of injury that may occur during activities at Heavenly Rhythm Dance Studio. I hereby waive, release, absolve, and indemnify the Heavenly Rhythm Dance Studio program, coaches, staff and the premises owners on which any of its activities may be held, for any claim.

Hold Harmless: I, on behalf of myself and the Participant(s) for whom I am completing this Liability Waiver & Release, release and hold harmless Heavenly Rhythm Dance Studio, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of related to any loss, damage, or injury that may be sustained by Participant(s).

Media Release: I give my permission for any photo or video of the Participant(s) for whom I am completing this Liability Waiver & Release (e.g., my child) taken while on the premises or in dance class at Heavenly Rhythm Dance Studio, or Heavenly Rhythm Dance Studio sponsored event, to be used for advertisement or promotion on the Heavenly Rhythm Dance Studio website or other social medias. (Note: dancer identity will not be released).

Infectious Diseases: By the signing of this Liability Waiver & Release, the undersigned acknowledges the contagious nature of COVID-19 and other infectious diseases, and voluntarily assumes the risk that they, and any Participant(s) for whom they are completing this Liability Waiver & Release form, may be exposed to or infected by COVID-19 or other infectious diseases by use of the property, facilities, services, and/or programs of Heavenly Rhythm Dance Studio and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned understands that the risk of becoming exposed to or infected by COVID-19 or other infectious diseases at, or on the premises of, Heavenly Rhythm Dance Studio may result from the actions, omissions, or negligence of themselves and others, including, but not limited to, Heavenly Rhythm Dance Studio and its staff, program participants and their families; and I acknowledge and agree that I am releasing and holding harmless Heavenly Rhythm Dance Studio and its owners and operators with respect thereto pursuant to the “Hold Harmless” section of this Liability Waiver & Release. I affirm my responsibility to immediately notify Heavenly Rhythm Dance Studio in the event of any known exposure of myself, and/or any Participant(s) for whom I am completing this Liability Waiver & Release Form to someone who has a positive or presumed positive (waiting for results) COVID-19 test in the last 14 days. I hereby agree, on behalf of myself and the Participant(s) for whom I am completing this Liability Waiver & Release, to ensure that myself, any such Participant(s) and any spectators known by me to be entering the premises of Heavenly Rhythm Dance Studio, or any Heavenly Rhythm Dance Studio event held at other locations, have not knowingly been exposed to someone who has a positive or presumed positive (waiting for results) COVID-19 test in the last 14 days, and are not experiencing any shortness of breath, fever, cough, sore throat, loss of taste or smell, chills, head or muscle aches, nausea, diarrhea or vomiting.

Electronic Signature: I consent to have my electronic signature on this document treated as a full and complete, legally binding signature.
Signature*

Clear
OFFICE USE ONLY:

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