Thistle Glen Dancer Registration

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Dancer's name (first, last) *

Birth Date *

Age *

Address *

Phone Number and Email Address *

Parent's Name(s) *

MEDICAL INFORMATION Alberta Health Care No. (*Note: This is just in case of an emergency event and the dancer needed medical attention - no decisions will be made without parental communication), *

Emergency Contact Name & Phone Number: *

List of Medications and/or Medical Conditions that may impact highland dancing *

Dance Level (Primary (age 4-6), Beginner (7+), Premier, etc.)

Intermediate/Premier/Adult Dancer - will you be dancing one a week or twice a week?

Once

Twice

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GENERAL RELEASE & WAIVER In consideration of your accepting this registration, I hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Thistle Glen School of Highland Dance, Edmonton, Alberta, its agents, representatives, owners, employees, successors and assignees, for any and all injuries or illness suffered by me or my child. I have read and agreed to the policies and regulations of Thistle Glen School of Highland Dance, including all fees and payment conditions. Further, in case of any emergency regarding the above registered student, you and/or the emergency contact will be called immediately. If either the parent(s) and/or emergency contact cannot be reached by phone, I authorize any qualified staff member to make any necessary decisions. I further undertake to indemnify Thistle Glen School of Highland Dance, its agents, representatives, owners, employees, successors and assignees, for any claims, however arising, made by me or on behalf of my child. *

PHOTO WAIVER: I consent to the use and publication of any photography or likeness of students taken in the course of classes, competitions, workshops, studio events or other activities for the promotional purposes of Thistle Glen School of Highland Dance, including, but not limited to, publication of my likeness and name (or that of my child) on the Thistle Glen School of Highland Dance website/social media. *

By adding your name underneath the general wavier and photo release, you have agreed to the terms.

Date of Registration *

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