AFRAkidz Registration Form
Term 4: 12 Oct - 16 Dec
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Child's Name *
Parent's Name:
Parent Phone/Cell *
Parent Email Address *
Medical concerns, allergies or physical limitations/injuries of child *
WAIVER: By ticking this form, my child and I both acknowledge that they will receive information and instruction in Dances of the African Continent and Diaspora. My child and I understand that dance involves physical movement which can result in strains, sprains, dislocations of joints or other injuries. As is the case with any physical activities, the risk of injury, even serious or disabling injury, is always present and cannot be entirely eliminated. I represent and warrant that my child has no medical condition or physical injuries that would be aggravated from their participation in the dance class. If my child experiences any pain or discomfort, they will immediately stop participating  in the class and notify the instructor (Heather Grant) and myself (their parents). My child and I agree to assume full responsibility for any risk, injuries or damages, known or unknown, which they might incur as a result of participating in AFRAkidz classes. I agree for myself, my heirs, executors and administrators not to sue, and I agree to release, indemnify and hold Ihuoma Dance / Heather Grant from any and all liabilities, claims, demands and causes of action arising out of my participation in the class and related activities, whether it results from the negligence of the instructor. My child and I have read the above release and waiver of liability and my child and I fully understand its contents. My child and I voluntarily agree to the terms and conditions stated above. *
Required
WAIVER:  By ticking this box my child and I agree or wish to decline from any photography or film being taken of my child. If you agree for photography/film to be taken, please make sure you and your child understand completely that this may footage may be used on social media for promotional purposes and/or for dance film submissions.
AGREEMENT TO COVID-19 PRECAUTIONS (you must read and agree (tick) to ALL requirements): *
Required
Payment method: (Due to COVID-19 Health and Safety measures, we cannot accept CASH at this time)
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I have made an electronic payment of (please only tick once payment has been made) *
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