2023-2024 Registration form

Dancer/applicant *

First Name

Last Name

Dancer's date of birth *

MM

DD

YYYY

Primary phone # (best chance of reaching you) *

(###)

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Parent/guardian (if applicant is 18 or over, you may indicate 'not' as the first name and 'applicable' as the last name) *

First Name

Last Name

Parent/guardian

First Name

Last Name

Secondary phone # (if desired)

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency contact (other than the parent(s)/guardian(s) named above *

First Name

Last Name

Emergency contact's phone # (best chance of reaching them) *

(###)

###

####

If you indicated any allergies or medical conditions above, is the applicant under a doctor's care for any of them?

YES

NO

If under a doctor's care, are they aware that the applicant is planning to take dance classes?

YES

NO

I understand and agree that everyone entering the studio must first self-screen for COVID-19 using the most up to date local and provincial guidelines, and must not enter the building if they are symptomatic, isolating or waiting for COVID-19 test results and/or as per health regulations. *

YES

NO

I agree to respect and follow Sudbury School of Dance's COVID-19 policies and procedures (as available on the website) and will, to the best of my ability, ensure that my child is aware of and abides by these guidelines. *

YES

NO

I understand that Sudbury School of Dance may change or update its COVID-19 policy during the dance year (as mandated locally or provincially) and agree to abide by any possible updates as they arise. *

YES

NO

I hereby release Sudbury School of Dance from any and all liability for unintentional exposure or harm due to COVID-19. *

YES

NO

I hereby give permission for photos/video of the applicant (myself or my child) taken during activities related to Sudbury School of Dance to be used for promotional purposes. *

YES

NO

I understand and agree that in participating in any dance class there is a possibility of physical injury. I voluntarily agree, therefore, to assume all risks and responsibility for any injury or accident which might occur to me or my child during any of the classes or activities at Sudbury School of Dance. I further hereby voluntarily agree to waive any and all claims I have/may have against Sudbury School of Dance, its owner, contractors, employees, volunteers, assistants, guest artists, and/or students and to release them from any and all liability for any injury, loss, damage, or expense which I, my child, our heirs, next of kin, executors, administrators, assigns and/or representatives may have, due to any cause whatsoever; and to hold them harmless from any and all claims, actions or damages resulting from participation in any activities offered by or associated with Sudbury School of Dance, on behalf of myself, the applicant named above, and any persons accompanying me to the premises. I acknowledge and accept the terms and conditions of studio policy and procedure. I am aware that any personal information collected by the studio will be kept confidential and is for studio use only. I further certify (if completing this form on behalf of a minor) that I am the parent or legal guardian of the participant named above and have the right to waive these rights. I have read, understood and agree to be bound by the above statement, whereby I waive certain legal rights. *

YES

NO

Date *

MM

DD

YYYY