2024 Dance Boot Camp
Join us for Dance Boot Camp August 19-22 from 9AM-12PM! Levels 4 & Up welecome.  Schedule: 9-10:30AM Ballet Class, 10:30AM - 12:00PM Alternating Ballet Variations, Jazz, Lyrical, Contemporary.  Dancers must be dressed in dress code.  $150 for the week per dancer. Payment due August 5, 2024.
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Student Name: *
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Parent/Guardian 2
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Does your child have any food allergies: *
If yes, please describe the food(s), severity of the reaction, and what is done in response to a reaction.
Please list and explain any illness, condition, injury or limitation that may prevent your child from participating fully in dance. *
If your child must take any medication while at dance camp, please note here. All medication must be in their original containers and be appropriately labeled.
Emergency Contact 1 (name and number) *
Emergency Contact 2 (name and number) *
To my knowledge, there is no physical or medical reason why I/my child should not participate in dance classes or any activities included in dancing, performing, etc. I certify that I have consulted with a physician regarding any illness, disability, or injury which I am aware of and have been cleared to participate fully, and without limitations, except as set forth below. I agree that I am fully responsible for any injury which may occur as a result of any illness, disability, or injury which I have and waive any claim for damages for such injury and hereby release and indemnify Southside Ballet Studio, LLC there from. Further, I hereby certify that the classes at Southside Ballet Studio, LLC involve physical activity during which injury can occur. I hereby assume the risk of same and waive any claim for damages due to injury which may occur from said activity and hereby release and indemnify Southside Ballet Studio, LLC there from. I hereby agree to follow all staff instructions, rules, and guidelines in the use of the facilities and equipment. Typing your name below signifies you have read this and acknowledge. *
I grant permission to Southside Ballet Studio, LLC and its’ agents or employees, to use photographs and/or video footage of me, or the minor named below, for use in studio publications including but not limited to, brochures, newspapers and the Southside Ballet Studio, LLC website at www.southsideballet.com. I grant Southside Ballet Studio, LLC the unrestricted right to use and publish photographs and/or video footage taken of me while participating in dance class, performing or in the company of Southside Ballet Studio, LLC. I waive any right to royalties or other compensation arising from the use of my photograph and/or video footage, and if signing on behalf of a minor named below, I waive all such rights of the minor named below. I agree on my own behalf or on behalf of the minor child named below, to release and hold harmless Southside Ballet Studio, LLC and its’ agents or employees from any claims arising from the related use of the photographs and/or video footage. I acknowledge that by typing my name below on this form I give Southside Ballet Studio, LLC full copyright and authority to publish photography and/or video footage and I agree to the terms listed above. *
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