Adult Ballet 2021-2022 Registration Form - Tuesdays 8-9pm
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Dancer's First and Last Name *
In Studio or Online? *
Dancer's Date of Birth:
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Contact email *
Contact Number *
COVID-19 Release - I understand and agree that even with social distancing and sanitization protocols, there is a possibility of contracting COVID-19 (coronavirus disease) while attending Emerge Dance Academy. I voluntarily agree, therefore, to assume all risks and responsibility of contracting COVID-19 which I could contract during any of Emerge Dance Academy Inc classes, rehearsals, performances, or activities. I also exempt and release, Emerge Dance Academy Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to myself or my property which may arise out of or in connection with COVID-19.  I understand and agree that I will not come to Emerge Dance Academy Inc if I am sick even if symptoms resemble a mild cold. Symptoms to look for include fever, cough, shortness of breath, sore throat, runny nose, nasal congestion, headache, and a general feeling of being unwell. *
Required
General Release- I understand and agree that in participating in any dance class, rehearsal, audition or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to myself during Emerge Dance Academy Inc classes, rehearsals, performances, or activities. I also exempt and release, Emerge Dance Academy Inc and its owners, employees, assistants, volunteers, guest artists, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to myself or my property which may arise out of or in connection with participation in any classes or activities conducted by Emerge Dance Academy Inc. I have alerted Emerge Dance Academy Inc of any and all medical conditions and allergies on my registration form. *
Permission is granted to Emerge Dance Academy Inc to use photographs and video of classes I may be in for promotional and publicity purposes. *
Preferred method of payment *
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