NEW Students - CORRISTON MOVEMENT & DANCE REGISTRATION (Winter/Spring 2023)
Please fill out this form for each dancer that you are registering.  Thank you!
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Dancer's Last Name *
Dancer's First Name *
Dancer's date of birth *
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Dancer's current age *
Address *
Name of Parent/Guardian #1 *
Phone Number for Parent/Guardian #1 *
Email address for Parent/Guardian #1 *
Name of Parent/Guardian #2
Phone Number for Parent/Guardian #2
Email Address for Parent/Guardian #2
Student Medical Conditions/Allergies
Name of the school that the dancer attends: *
Check the  correct class(es) for this student (email corristonmad@gmail.com with questions about level): *
Required
CANCELLATION POLICY: Registration Fees are non-refundable.  Tuition refunds will be issued only when cancellation is due to a medical condition or before the third class session.  No refunds will be given on classes missed due to school holidays, conflicting activities or choosing not to continue.  However, whenever possible, CMAD will attempt to schedule make-up sessions for classes that were cancelled due to inclement weather. *
Required
General PARTICIPANT CONSENT & LIABILITY RELEASE WAIVER: As the parent of the registering student, I hereby consent to his/her participation in dance lessons, instructional programs, recitals and other activities provided by Corriston Movement and Dance, LLC (CMAD).  I understand that dance is a physical activity and that there are risks involved.  In consideration of my child receiving services as described above, I agree to release, hold harmless and indemnify CMAD, and its owner Amber Corriston, employees and instructors from any and all claims, actions, causes of action, damages and attorney fees, arising from personal injuries that may be sustained by my child resulting from participation in the programs provided by CMAD.   PARENT SIGNATURE: *
CMAD COVID-19 LIABILITY WAIVER:  The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend wearing a facemask. CMAD has put in place preventative measures to reduce the spread of COVID-19; however, CMAD cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending CMAD could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I agree that I will not participate in or send my child to any CMAD classes if I/my child show any of the following symptoms of Covid-19.  Symptoms may include, but not limited to:● Fever of 99.5 in the last 72 hours● Persistent cough● Difficulty breathing● Chills● Muscle pain● Sore throat● Loss of taste or smell. By signing below I also acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted. LEGAL GUARDIAN/PARENT/CAREGIVER/PARTICIPANT SIGNATURE: *
PHOTO RELEASE: I give permission for CMAD to use pictures of my child on the CMAD website.  Names of students will not be used in any posts.  PARENT SIGNATURE:
I acknowledge that payment includes the Spring Show Fee and that without payment through Square, there will not be a spot held for my dancer in this class.  PARENT SIGNATURE: *
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