SUMMER DANCE RELEASE FORM
Wednesdays -- July 7-July 28
NEW LOCATION: 3419 Central Avenue
Thursdays -- July 8-July 29
Young performers Intensive Summer Dance Workshop
WEDNESDAYS
4:30-5:30 p.m. (Ages 7 through 10)
5:30-6:30 p.m. (Ages 11 through 18)
6:30-7:30 p.m. Acro Sports
THURSDAYS
5:30-6:30 p.m. (Ages 3-6) Tiny Tots Class
6:30-7:30 -- CELTIC DANCING
7:30-8:30 -- Hip Hop
SATURDAYS
9:00-10:00 -- Hip Hop, Advanced
10:00-11:00 -- Tap Dancing, Advanced
The cost for one session is $55; two sessions $90; three sessions $125
DANCER’S NAME_______________________BIRTHDATE: mm/dd/yyyy)_____________
MAILING ADDRESS:_____________________CITY________ ST______ZIP_________
TELEPHONE:___________________EMAIL:___________________________________
CELL NUMBER:_________________________
1. Overview. I/we have enrolled the above-named student at RimView Dance Studio (from now on referred to as “RDS”) for dance training. It is understood that from time-to-time it will be necessary for RDS to arrange for the services of independent contractors to manage and/or operate RDS as a dance training and instruction institute. I/we agree to hold harmless, discharge and release RDS from any and all liability for injury, loss, damage, obligation, expense, or penalty sustained by Student which arises out of or in connection with the Student’s participation at RDS.
2. Liability. I/we acknowledge that Student will be physically touched from time-to-time during his/her dance training and instruction and that I/we will not hold RDS liable for such physical touching. In addition, RDS will not be held liable for and will be held harmless from any and all liabilities, losses, injuries, damages or expenses related to the Student’s dance training at RDS or participation in RDS sponsored events.
3. Consent for Emergency Treatment. In case of emergency, RDS is authorized to arrange for medical services for the Student and I/we consent to appropriate medical and surgical service recommended by licensed medical professionals. I/we accept full responsibility for all costs of said medical care and any emergency treatments. RDS will not be responsible for the cost of any medical care of emergency treatments but it may accept billing in its name only to facilitate submission of medical insurance claims for the Student, if applicable, or for the prompt forwarding of bills to me/us; I/we agree that RDS will not be held liable for authorizing medical treatments for the Student pursuant to my/our authorization in this paragraph and I/we hereby waive all claims whatsoever in connection with such medical treatments. I/we agree that RDS will not be held liable for and agree to hold RDS harmless from any and all liabilities, losses, injuries, damages or expenses related to the Student’s participation in any of the activities at RDS and from the Student’s enrollment at RDS generally. Any and all claims against RDS are waived. Any damage and/or harm by the Student will be the responsibility of the parent/legal guardian.
4. Consent to Participate in RDS Productions. I/we grant permission for the Student to participate in the dance recitals and productions at RDS, or other locations for the duration of his/her enrollment in RDS with full knowledge or the risks inherent in dancing or related activities. Accordingly, I hereby release RDS from any and all liabilities arising out of my child’s participation in any rehearsal and/or performance.
5. Responsibility during Rehearsals and Performances. I/We understand that I/We are fully responsible for my/our dancer(s) costume changes, hairpieces, make-up and overall needs. I/We understand that I/We have to be present for competitions.
PRINT PARENT/GUARDIAN’S NAME__________________________________________________________________
SIGNATURE OF PARENT/GUARDIAN__________________________________DATE:_______________