Master Class with Sonya Charette-Bodo

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Please fill out the following form to register to your dancer for the acro dance workshop with Sonya Charette-Bodo!

A $25 deposit is due at the time of registration that will be applied to the total fee of the workshop. You will be sent an invoice for this payment upon completion of this form. The remaining fee will be due on the day of the workshop.

Email *

Dancer First and Last Name: *

Dancer Date of Birth: *

YYYY

Dancer Age: *

Parent/Guardian First and Last Name: *

Relationship to Dancer: *

Mother

Father

Grandmother

Grandfather

Legal Guardian

Other:

Parent/Guardian Email: *

Parent/Guardian Phone: *

Please select the workshop you would like to register for: *

Acro Dance Workshop (Ages 6 to 9) on 7/26/23 from 8:30 to 9:30am

Acro Dance Workshop (Ages 10+) on 7/26/23 from 9:30am to 12:30pm

Required

Total Amount Due: *

$35 (Ages 6 to 9)

$50 (Ages 10+)

How will payment be made? *

Cash (dropped off to 15 North Street, Presque Isle, ME)

Check (mailed to PO Box 563, Mapleton, ME 04757)

Venmo (please provide handle below)

PayPal (please provide handle below)

If you chose Venmo or PayPal please provide your handle below: *

Waiver and Release from Liability

I have chosen to have my child(ren) participate in dance instruction given by MoonDance Studios (MDS). I acknowledge that I understand the nature of the activities my child will be participating in and that my child is in the proper physical condition and capable of participating in the related activities, understanding that MDS is not in any way responsible for making such a determination.

In consideration of my child’s enrollment in any dance instruction program, I understand and agree on behalf of myself and my child, to release, hold harmless, and discharge MDS from all claims, costs, liabilities, expenses or judgments, including attorneys’ fees and court costs for any occurrences in connection with any dance instruction. I assume all risks to my child in connection with any instruction and further release MDS and its owners and instructors from liability for any injury sustained by my child while he or she is enrolled in any dance instruction program, including all risks reasonably connected with such activity whether foreseen or unforeseen.

I understand that MDS is not responsible for my child or other children under my supervision who are left unsupervised in the common areas and areas surrounding the dance studio and that MDS will only be supervising my child when he or she is participating in scheduled dance/tumbling activities, programs or instruction. I understand that MDS is not responsible for personal property that is lost, damaged or stolen while I or my child is at or on MDS property.

I authorize and agree that MDS may take and use photographs, videos or likenesses of myself or my child as needed for its record-keeping, advertising and/or public relations projects and that I have no rights to the same and will not be compensated for the same.

My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.

I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO SIGNING.

By typing your full name in this box you agree that you have fully informed yourself as to the contents of the above release and have read the release in it's entirety.
*

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