"*" indicates required fields 1Enrollment & Emergency Information2Liability Release / Waiver3Photo & Video Permission URLThis field is for validation purposes and should be left unchanged.Student InformationStudent's Full Name* First Last Gender Female Male Non-Binary Prefer Date of Birth Nickname (if any)Address Street Address Address Line 2 City State ZIP Code SchoolGradeParent / Guardian InformationParent/Guardian #1 NameRelationship to StudentPhoneEmail Parent/Guardian #2 NameRelationship to StudentPhoneEmail Emergency Contact(Other than Parent/Guardian)NameRelationship to StudentPhoneAlternate PhoneMedical InformationDoes your child have any medical conditions? Yes No If yes, please explainAllergies (medications, foods, etc.)Medications (name, dosage, frequency)Doctor's NamePhoneHealth Insurance CompanyPolicy/ID #In Case Of EmergencyI authorize Studio Danza staff to obtain emergency medical care for my child if I cannot be reached.Parent/Guardian SignatureDate Please Read Carefully Before SigningI understand that dance and physical activity involve inherent risks of injury, including but not limited to muscle strains, sprains, falls, collisions, and other injuries. I understand that Studio Danza, its board of directors, instructors, staff, volunteers, event sponsors, and authorized representatives are not liable for injuries, accidents, or illnesses that may occur while participating in classes, rehearsals, workshops, performances, events, or while on the premises, except as prohibited by law. I voluntarily assume the ordinary risks associated with participation and, to the fullest extent permitted by applicable law, release and hold harmless Studio Danza from claims arising from those ordinary risks. I understand that I am responsible for safeguarding personal belongings. Studio Danza is not responsible for lost, stolen, or damaged personal property except as required by law.Student InformationStudent's Full Name First Last Date of Birth Parent / Guardian AcknowledgementI have read this Liability Release / Waiver, understand its contents, and sign it voluntarily. I certify that I am at least 18 years old and legally authorized to sign for myself or for the minor participant identified above.Parent/Guardian NameParent/Guardian SignatureDate Please Read CarefullyStudio Danza may take photographs and/or video recordings during classes, rehearsals, workshops, performances, community events, and other Studio Danza activities for promotional, educational, program, grant, community presentation, website, social media, and communication purposes.Student InformationStudent's Full Name First Last Date of Birth Permission Options (Please Check One)Permission Options YES, I give permission for Studio Danza to use photographs and/or videos of me or my child for the purposes described above. NO, I do NOT give permission for Studio Danza to use identifiable photographs and/or videos of me or my child for promotional purposes. Parent / Guardian AcknowledgementI understand that this permission is voluntary. Studio Danza will make reasonable efforts to honor my selection. This permission does not authorize Studio Danza to sell an individual's image as a standalone commercial product.Parent/Guardian NameParent/Guardian SignatureDate
