Revolution Elite Dance Summer Dance Intensive 2023 Registration Form

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Registration Opens April 14, 2023

Contact Email *

Contact Phone Number *

Dancers First and Last Name *

Dancer Date of Birth *

YYYY

Dancers Age *

Parent First Name *

Parents Last Name *

Emergency Contact Name (OTHER THAN PARENT): *

Emergency Contact - Preferred Phone Number: *

Emergency Contact - Relationship to Student *

PLEASE LIST ANY ALLERGIES, PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS THE STUDENT MAY HAVE: *

How did you hear about us? *

Waiver and Release Information: I attest that the above stated physical, mental, and emotional limitations of the student are accurate. I understand that dance and tumbling, sometimes involves extraordinary use of motion. When practicing the art of dance, there are some possibilities for but not limited to the injury of muscle or bones. In consideration for using/ allowing my child/ self, to utilize the facility and staff of Revolution Elite Dance; I hereby forever release the owners, staff, directors, coaches, and all other employees from liability for any injuries suffered by myself or any student in connection with the uses of this facility at 5614 126th Street. I acknowledge that participation is entirely by choice and I am under no compulsion by Revolution Elite Dance to participate in the programs, nor am I being paid to do so. The interest of myself and my child is solely to participate in the art and his/her self-improvement, and I am willing to accept the inherent risk in this pursuit.

Please read statements below and checkbox to indicate you agree to all Waiver and Release Information: *

I also understand that my child will not participate in class or RED events if all fees are not paid.

Registration fees/ tuition fees are non- refundable or transferable.

I understand that if my child is sent to class not wearing appropriate attire, he/she will be required to sit and watch. He/she WILL NOT be allowed to participate in class.

Revolution Elite Dance also holds the right to dismiss any students from the facility that they feel is not behaving or representing the studio in an acceptable manner.

I grant Revolution Elite Dance & all teachers/staff to post my dancer’s picture on social media.

Required

This acknowledgment of risk and waiver having been read thoroughly and understood completely is signed voluntarily as to its intents and contents. Electronic Signature required. *Type First & Last Name in space provided. *

This acknowledgment of risk and waiver having been read thoroughly and understood completely is signed voluntarily as to its intents and contents. Date of Completion. *

YYYY

Permission to Administer Emergency Treatment

In my absence, and as a parent or legal guardian of ________________________(student name), I hereby grant my permission, in the event of sickness or injury, to have the necessary treatment administered to my child by a trained professional. *

In addition, I also grant my permission to have my child transported to the hospital, doctor’s office, or an emergency clinic in the event of such injuries or illness *

YES

Electronic Signature of Parent/Guardian Required *

Please indicate the weeks your student will be available for summer classes. SELECT ALL THAT APPLY. REMINDER - YOUR FULL PAYMENT AMOUNT WILL BE DETERMINED BY WEEKS SELECTED AT REGISTRATION. Classes are $90 a week. July classes are due July 10th. *

WEEK 5: JULY 10 - 13

WEEK 6: JULY 17 - 20

WEEK 7: JULY 24 - 27

Required

Registration and Refunds: Registration for summer camp must be completed online and then we will contact you to set up payment. $30 registration fee or $50 family registration fee is due at the time of registration to reserve the dancer’s spot as well as a $90 deposit, if you pay in full you will not need to pay the deposit. Classes are $90 a week.

Recital 2023 dancers’ registration fees will be $20 and $30 for the family. If payments are not received prior to the due date, your registration will be canceled without any refund. Payment must be made before the dancer attends class. Your dancer will not be allowed into the classroom if tuition hasn’t been cleared.

Please indicate the class(es) student is interested in taking this summer. Our classes are broken down by level, not age. Summer levels are not the same as Fall/ Spring levels so every dancer will be evaluated by staff. *NEW TO RED - levels to be discussed over telephone conference. Make selection you feel best suited for your dancer and be advised levels will be reviewed by Hannah Granville Beasley. Please observe call meeting days/times available below.
*

AGES 10 - 18+ Beginner/ Intermediate Level

Ages 10 - 18+: Intermediate/ Advance Level

CLASS INFORMATION:

Ages 10-18+ INFORMATION

Int./Adv. Monday and Wednesday 1:30pm – 4:30pm
Beg./ Int. Tuesday and Thursday 1:30pm – 4:30pm

New to RED: Please set up an appointment with Hannah Granville Beasley to finalize summer registration for 2023. Please select the preferred time slot for telephone appointment. Appointment meetings should take no longer than 10 minutes. *

Monday

Tuesday

Wednesday

Thursday

RETURNING DANCER

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