Registration Form & Liability Waiver






Fields marked * are required

Parent/Guardian Information:

First & Last Name(s)*: Primary Phone#*:
HomeCellWork
Email Address*: Alternate Phone#:
HomeCellWork
Street Address*: City*:
State*: Zipcode*:
How did you find us?* Promo Code:

Emergency Contact Information:

First & Last Name(s)*: Primary Phone#*:
HomeCellWork
Relationship to Student*: Alternate Phone#:
HomeCellWork

Student Information:

Student #1
First & Last Name*:

Date of Birth*:

Grade Level:

Name of School:

Does this student have any prior dance experience?
YesNo
Fall 2017 Class Selections:
Tot Pre-Ballet {2-1/2 to 3 years old} (THU 11:00-11:30am)Tot Ballet/Tap Ia {2-1/2 to 4 years old} (WED 5:45-6:30pm)Tot Ballet/Tap Ib {2-1/2 to 4 years old} (THU 10:00-10:45am)Tot Ballet/Tap Ic {2-1/2 to 4 years old} (SAT 9:00-9:45am)Tot Ballet/Tap II {5 to 7 years old} (SAT 9:45-10:45am)Ballet Ia {Beginner} (MON 5:00-5:45pm)Ballet IIa {Intermediate} (WED 6:30-7:15pm)Ballet IIb {Intermediate} (THU 6:45-8:00pm)Ballet III {Advanced} (MON 7:30-9:00pm)Cecchetti {Grade 3} (MON 6:30-7:30pm)Cecchetti {Grade 4} (TUE 6:30-7:30pm)ASD/Sensory Movement (SAT 11:00-11:30am)
Tap I {Beginner} (WED 5:00-5:45pm)Tap II {Intermediate} (TUE 5:45-6:30pm)Boys Hip Hop I {Beginner} (THU 5:00-5:45pm)Hip Hop II {Intermediate} (TUE 5:00-5:45pm)Jazz IIa {Intermediate} (MON 5:45-6:30pm)Jazz IIb {Intermediate} (THU 5:45-6:45pm)Teen Jazz (TUE 8:15-9:00 pm)Teen Tricks & Turns (WED 7:15-8:00pm)N.Y.T.B.C. Rehearsal (SAT 11:30-2:30am)Adult Ballet Workout (TUE 7:30-8:15pm)Adult Contemporary (THU 9:00a-10:00am)Adult Tap (WED 8:00-8:45pm)
Student #2
First & Last Name:

Date of Birth:

Grade Level:

Name of School:

Does this student have any prior dance experience?
YesNo
Fall 2017 Class Selections:
Tot Pre-Ballet {2-1/2 to 3 years old} (THU 11:00-11:30am)Tot Ballet/Tap Ia {2-1/2 to 4 years old} (WED 5:45-6:30pm)Tot Ballet/Tap Ib {2-1/2 to 4 years old} (THU 10:00-10:45am)Tot Ballet/Tap Ic {2-1/2 to 4 years old} (SAT 9:00-9:45am)Tot Ballet/Tap II {5 to 7 years old} (SAT 9:45-10:45am)Ballet Ia {Beginner} (MON 5:00-5:45pm)Ballet IIa {Intermediate} (WED 6:30-7:15pm)Ballet IIb {Intermediate} (THU 6:45-8:00pm)Ballet III {Advanced} (MON 7:30-9:00pm)Cecchetti {Grade 3} (MON 6:30-7:30pm)Cecchetti {Grade 4} (TUE 6:30-7:30pm)ASD/Sensory Movement (SAT 11:00-11:30am)
Tap I {Beginner} (WED 5:00-5:45pm)Tap II {Intermediate} (TUE 5:45-6:30pm)Boys Hip Hop I {Beginner} (THU 5:00-5:45pm)Hip Hop II {Intermediate} (TUE 5:00-5:45pm)Jazz IIa {Intermediate} (MON 5:45-6:30pm)Jazz IIb {Intermediate} (THU 5:45-6:45pm)Teen Jazz (TUE 8:15-9:00 pm)Teen Tricks & Turns (WED 7:15-8:00pm)N.Y.T.B.C. Rehearsal (SAT 11:30-2:30am)Adult Ballet Workout (TUE 7:30-8:15pm)Adult Contemporary (THU 9:00a-10:00am)Adult Tap (WED 8:00-8:45pm)
Student #3
First & Last Name:

Date of Birth:

Grade Level:

Name of School:

Does this student have any prior dance experience?
YesNo
Fall 2017 Class Selections:
Tot Pre-Ballet {2-1/2 to 3 years old} (THU 11:00-11:30am)Tot Ballet/Tap Ia {2-1/2 to 4 years old} (WED 5:45-6:30pm)Tot Ballet/Tap Ib {2-1/2 to 4 years old} (THU 10:00-10:45am)Tot Ballet/Tap Ic {2-1/2 to 4 years old} (SAT 9:00-9:45am)Tot Ballet/Tap II {5 to 7 years old} (SAT 9:45-10:45am)Ballet Ia {Beginner} (MON 5:00-5:45pm)Ballet IIa {Intermediate} (WED 6:30-7:15pm)Ballet IIb {Intermediate} (THU 6:45-8:00pm)Ballet III {Advanced} (MON 7:30-9:00pm)Cecchetti {Grade 3} (MON 6:30-7:30pm)Cecchetti {Grade 4} (TUE 6:30-7:30pm)ASD/Sensory Movement (SAT 11:00-11:30am)
Tap I {Beginner} (WED 5:00-5:45pm)Tap II {Intermediate} (TUE 5:45-6:30pm)Boys Hip Hop I {Beginner} (THU 5:00-5:45pm)Hip Hop II {Intermediate} (TUE 5:00-5:45pm)Jazz IIa {Intermediate} (MON 5:45-6:30pm)Jazz IIb {Intermediate} (THU 5:45-6:45pm)Teen Jazz (TUE 8:15-9:00 pm)Teen Tricks & Turns (WED 7:15-8:00pm)N.Y.T.B.C. Rehearsal (SAT 11:30-2:30am)Adult Ballet Workout (TUE 7:30-8:15pm)Adult Contemporary (THU 9:00a-10:00am)Adult Tap (WED 8:00-8:45pm)

*Please keep in mind that enrollment in some classes requires prior instructor approval. You will receive separate confirmation and request for payment directly from the studio once your registration has been received and processed.

Do you have any additional questions or comments?


Liability Waiver, Media Release & Hold Harmless Agreement

In consideration of permission granted by Front Street Dance allowing me to participate in dance classes which will occur on a weekly basis, I (together with my parent or guardian, if I am under the age of eighteen or under a legal disability) represent, covenant, and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows:

I acknowledge that participating in dance classes involves certain risks (some of which I many not fully appreciate) and that injuries, death, or other harm could occur to me or others. I accept and voluntarily incur all risks of any injuries, damages, or harm which arise during or result from my participation in dance classes, regardless of whether or not caused in whole or in part by the negligence or other fault of Front Street Dance or its employees.

I waive all claims against any of the Released Parties for any injuries, damages, losses, or claims, whether known or unknown, which arise during or result from my participation in dance classes, regardless of whether or not caused in whole or in part by the negligence or other fault of any of the Released Parties. I release and forever discharge the Released Parties from all such claims.

I agree to indemnify and hold the Released Parties harmless from all losses, liabilities, damages, costs, or expenses (including, but not limited to, reasonable attorneys’ fees and other litigation costs and expenses) incurred by any of the Released Parties as a result of any claims or suits that I (or anyone claiming by, under, or through me) may bring against any of the Released Parties to recover any losses, liabilities, costs, damages, or expenses which arise during or result from my participation in dance classes, regardless of whether or not caused in whole or in part by the negligence or other fault of any of the Released Parties.

I release/hold harmless Front Street Dance, including all staff, instructors, and volunteers, from any and all liability to the student caused by or resulting from the student’s participation in any classes or programs conducted by Front Street Dance. Even when every precaution has been taken to avoid any injuries, any time a child participates in any physical activity, there is a chance of injury and parents/guardians should be aware of this fact.

I do hereby grant permission to Front Street Dance to use images of my child in promotional materials. Such use includes the display, distribution, publication, transmission, or other use of photographs, images, and/or video of my child for use in materials that include, but may not be limited to, printed materials (such as brochures, newsletters, posters, and other print advertising), digital materials (such as Front Street Dance’s website, electronic newsletters, blog, and emails), and social media (such as the Front Street Dance Facebook page, Twitter feed, or other social media platforms).

I understand that my child’s name will NOT be used in conjunction with any video or digital images for security and privacy purposes.

Agreed to Waiver* By checking this box, I am affirming that I have carefully read and reviewed this Liability Waiver, Media Release, and Hold Harmless agreement. I understand it fully and I execute it voluntarily. Furthermore, I have read, understand, and agree to abide by the tuition policies set forth by Front Street Dance. If my child is to be withdrawn from class, I agree to give written notice to the studio; otherwise, tuition charges will continue to accrue.