SUMMER WORKSHOP 2024 REGISTRATION FORM
**Early Bird Rates valid if paid by 6/1/24**
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Student Full Name: *
Student's Current Age: *
Parent/Guardian Name: *
Parent/Guardian Phone Number: *
Please check off all classes you would like to register for:

**PLEASE NOTE THAT THE HIP HOP & INT. ACRO WORKSHOPS ARE SOLD OUT!**
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By clicking below, you agree to the following Release of liability: I, the below signatory, for myself and on behalf of my/my child's heirs and personal representatives in consideration of my child's participation in any dance or related activities while attending Pirouette Dance Academy, Inc., hereby release, acquit and forever discharge Pirouette Dance Academy, Inc, the venue where the dance classes and activities are held, Kiirsten Elyse Flanders and any other instructor, and respective employees, agents, owners, officers, directors, partners, licensees and affiliates and all of their respective heirs, personal administrators, executors, successors and assigns (collectively, "Releasees"), of and from any and all claims, actions, causes of actions, demands, rights, damages, costs, expenses, lost wages and loss of services of any kind whatsoever for personal injury and/or property damage, known or unknown, which may result from my participation or child's participation in, preparation for, or any other activity/ies associated with Pirouette Dance Academy, Inc., and whether arising before, during or after such activity/ies. I further covenant not to sue any of the Releasees for or on account of any such injury(ies).I hereby acknowledge that I or my child is physically and mentally capable of participating in classes at Pirouette Dance Academy, Inc. and the activities associated therewith. Furthermore, I am familiar with the risks incidental to participation in such dance or events, and assume full responsibility for the risk of bodily injury or property damage due to the inherent risk of dance and such activities while in or upon the premises in which the classes take place while for any purpose participating in the aforementioned activities, and hereby expressly waive, release and forever discharge all Releasees of and from any and all claims of any nature which may be occasioned by participation in these events. In further consideration of the publicity afforded to my child as a participant at the dance studio, I hereby grant permission to Pirouette Dance Academy, Inc. and their affiliates and promotional agencies to use my child's picture, name, likeness and/or voice in any and all manner and media (including but not limited to the internet) throughout the United States in perpetuity for the purpose of publicizing myself or my child's participation at Pirouette Dance Academy, Inc. and for marketing, promoting or advertising for the studio, without fee or payment of any kind, and hereby release all of such parties from any claims that I/we may have for invasion or violation of rights of privacy, rights of publicity or any other cause of action arising out of such usage. I hereby waive any right to pre-approve usage of my child's picture, name, likeness or voice before release or publication and agree that any such usage may be edited in our sole discretion. *
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