Dance

Parent Name

Parent Phone Number

Address

Doctor

Doctor Phone Number

Participant one Name and Grade

Participant two Name and Grade

Participant three Name and Grade

Participant four Name and Grade

T Shirt Size

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult XS

Adult S

Adult M

Adult L

Adult XL

Participant one

Participant two

Participant three

Participant four

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Class

Kinder-2nd 4:00-5:00pm

3rd-6th 5:00-6:00pm

Participant one

Participant two

Participant three

Participant four

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Photo Release

Yes

No

Participant one

Participant two

Participant three

Participant four

Clear selection

By my electronic signature below, I acknowledge that physical activities create inherent risks of injury to my person. I, hereby, assume these risks, waive and release Baker of Chamber of Commerce and Agriculture, Baker Schools, and those associated from any and all claims for damages or other loss which might suffer while participating in Chamber sponsored physical activities or as a result of my use of the equipment or facilities. I the participant/parent, completely agree and will not hold any of the before mentioned entities liable for any injuries or damages both known and unknown whatsoever. If the participant is under the age of 18 years, a parent or legal guardian must sign below to release your child to participate. No refunds after classes have started

Please sign below

*

Code of Conduct *

Agree

I understand that the use of foul language towards anyone (coaches, volunteers, other participants, Chamber Director, and Chamber Assistant/Rec Director, Baker Chamber Board of Directors) will not be tolerated. I will not engage in any language or actions with the intent to initiate, hurt, intimidate or humiliate any player, coach, volunteer, spectators,Chamber Director, or Chamber Assistant/Rec Director.

I will encourage my child to play by the rules and to resolve conflicts without resorting to hostility or violence. I will advise that my child treats all players,coaches,volunteers, and Baker Chamber employees with respect.

I will support the coaches/volunteers and allow them to do their job by not coaching my child or other players. I will not openly question or confront coaches before, during, or after practices. I will take the time to speak with coaches about any concerns calmly, privately, and at an agreed upon time and place.

Agree

I understand that the use of foul language towards anyone (coaches, volunteers, other participants, Chamber Director, and Chamber Assistant/Rec Director, Baker Chamber Board of Directors) will not be tolerated. I will not engage in any language or actions with the intent to initiate, hurt, intimidate or humiliate any player, coach, volunteer, spectators,Chamber Director, or Chamber Assistant/Rec Director.

I will encourage my child to play by the rules and to resolve conflicts without resorting to hostility or violence. I will advise that my child treats all players,coaches,volunteers, and Baker Chamber employees with respect.

I will support the coaches/volunteers and allow them to do their job by not coaching my child or other players. I will not openly question or confront coaches before, during, or after practices. I will take the time to speak with coaches about any concerns calmly, privately, and at an agreed upon time and place.

I realize that if I violate this Code of Conduct I may be subject to disciplinary action that could include one or more, but not limited to the following:
*

Agree

Written or verbal warning by Chamber Director, Chamber Assistant/Rec Director, or Board of Directors

Parental suspension

The removal of child/children from the current program with no refund and will have to meet with the Chamber Board of Directors to discuss if child/children can rejoin

By electronically signing below, the Parent/Guardian agrees to abide by and be subject to this code of conduct

Payment (please select one)

One Participant $45.00

Two Participants $90.00

Three Participants $135.00

Four Participants $180.00

Clear selection