Student's
Name:
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Today's
Date : |
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xx/xx/xxxx |
Date
of Birth:
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xx/xx/xxxx
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Age:
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Student's
Cell Phone: |
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(Include
Area Code) xxx-xxx-xxxx |
Student's
Email Address: |
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Student's Home
Address: |
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City: |
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State:
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Zip
Code:
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Home
Phone:
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(Include
Area Code) xxx-xxx-xxxx |
Father's
Name:
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Mother's
Name: |
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Father's
Employer: |
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Mother's
Employer: |
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Father's
Work Phone: |
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(Include
Area Code) xxx-xxx-xxxx |
Father's
Cell Phone: |
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(Include
Area Code) xxx-xxx-xxxx |
Mother's
Work Phone: |
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(Include
Area Code) xxx-xxx-xxxx |
Mother's
Cell Phone: |
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(Include
Area Code) xxx-xxx-xxxx |
Father's
Email Address: |
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Mother's
Email Address: |
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What
Was Your Previous Dance Training
/ How Long & Where? |
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List Class
Division:
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Tuition Amount:
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Annual Registration Fee:
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Release
Request & Hold Harmless Agreement: |
I
request permission for my child/myself,
to participate in the classes
at the Cassandra School of Ballet
for the 2015-2016 school year.
Parents agree to and understand
that the teaching methods at Cassandra
Ballet will often include "hands-on"
instruction. Physical contact
may be necessary to insure correct
alignment and teaching technique
for the students. I further request
permission for my child or myself
(if over 18 yrs. of age) to participate
in performances, if eligible,
during the aforementioned school
year. I understand that in order
for my child or myself to participate
in the performance, my child/I
must attend all rehearsals and
be present at the mandatory dress
rehearsals. I permit any photos
of my child be used by Cassandra
Ballet for media publicity purposes.
In exchange for that permission,
I for myself and/or my child and
for our heirs and assigns do hereby
release and agree to hold harmless
the Cassandra School of Ballet
and its directors, officers, employees,
agents, successors and assigns
from all claims and demands of
any kind, including claims for
injuries to person or property
and defense costs and attorney’s
fees, arising out of or related
to, directly or indirectly, my
child’s/my participation
in the classes, rehearsals, performances
and photography usage for the
2015-2016 school year. I am fully
familiar with my child’s/own
physical condition and limitations,
and assume all risks of injury
for my child/my person or property
that my child/I may sustain in
connection with participation
in the 2015-2016 school year,
rehearsals and performances. |
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I
understand there are NO REFUNDS
(tuition, performance fees/costumes)
for student suspension or voluntary
withdrawal from the school program. |
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I
have read and fully understand
the terms of this Release Request
and Hold Harmless Agreement.
You agree your electronic Signature
is the legal equivalent of your
manual signature for this Agreement.
By signing this Agreement, you
consent to be legally bound by
the Agreement's terms and conditions. |
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Signature
of Parent or Guardian: |
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Date: |
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xx/xx/xxxx |
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Signature
of Student (If Over 18 Yrs): |
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Date: |
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xx/xx/xxxx |
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Cassandra
School of Ballet
will
not share or sell your personal
information.
See our Privacy
Policy page for additional
information. |