Special Studio Event Registration
Welcome to Dance Local! Please complete this form and payment to register for a Dance Local Special Event. Email me anytime, dancelocalnj@gmail.com. Thanks! Meg 
Sign in to Google to save your progress. Learn more
Email *
Parent Name (First & Last) *
Parent's Best Contact Phone # *
Participant #1 Name *
Participant #1 Age (years, months) *
Participant #1 Event Selection *
Participant #2 Name
Participant #2 Age (years, months)
Participant #2 Event Selection
Clear selection
Type Name as Electronic Signature below to consent. 

Under 19 years of age - I, the minor’s parent and/or legal guardian, understand the nature of dance and movement activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations and further agree that if despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim. In consideration of being permitted to participate in any way in Dance Local programming, I, for myself, my personal representatives, assigns, heirs, and next of kin. Age 19 years and older - I acknowledge, agree, and represent that I understand the nature of dance and movement activities and that I am qualified, in good health, and in proper physical condition to participate in such activity. I further acknowledge that the activity will be conducted at Dance Local facilities. I further agree and warrant that if at any time, I believe conditions to be unsafe, I will immediately discontinue further participation in the activity. Fully understand that (a) dance and movement activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis, and death (“Risks”); (b) these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the conditions in which the activity takes place, or the negligence of the “releasees” named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I may incur as a result of my participation in the activity. Hereby release, discharge, and covenant not to sue the club, the lab, its respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place,(each considered one of the “Releasees” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations. and, I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement I, or anyone on my behalf, makes a claim against any of the releasees, I will indemnify, save, and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

I hereby consent to the publication and use of my child’s and my own name and/or my child’s and my own likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by Dance Local, LLC or any other representative authorized to act on behalf of the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound and/or video recordings, films, broadcasts, brochures, publications, reports, web pages, promotional materials, or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of Dance Local, LLC and that neither I, nor my child, shall have any right of review or approval regarding the use of my child’s name and/or Likeness in such material. I hereby release and hold harmless, Dance Local, LLC along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, or causes of action arising out of the use of my child’s name and/or Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s name and/or Likeness by Dance Local, LLC.
*
Additional comments? Please share anything you'd like us to know about your children/family ahead of the event including allergies or medical information. If you prefer to email or call, please do - dancelocalnj.com/contact. Thank you.  
Payment is required to complete registration. What payment method will you use for this transaction? Please name the registrant and event title in the memo. Thank you!

Earth Day Walk & Dance, 4/22, 3:30-5pm: $36/pp ($37 via Venmo)
*
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy