SDS 2019-2020 Registration Question Title * 1. Dancer First and Last Name Question Title * 2. Dancer Birthday (MM/DD/YY). Adult dancers MM/DD is sufficient. Question Title * 3. Parent Name, Address, Phone, and Email address Name Address City/Town ZIP/Postal Code Email Address Phone Number Question Title * 4. Medical Conditions SDS should be aware of (e.g. allergy, migraine, etc.) Question Title * 5. I am registering my dancer for the following classes. (SDS will help place dancers in the correct class). Pre-Ballet Pre-Ballet/Tap Ballet/Tap 1 Ballet/Tap 2 Hip Hop 1 Hip Hop 2 Hip Hop 3 Adult Hip Hop & Jazz Jazz/Tap 1 Jazz/Tap 2 Jazz/Tap 3 w/ Miss Allison Jazz/Tap 3A w/ Miss Valerie Jazz/Tap 4 Jazz/Tap 5 Beginner Adult Tap Intermediate Adult Tap Tapped Out Lyrical 1 Lyrical 2 Poms 1 Poms 2 Classical Ballet 1 Classical Ballet 2 Classical Ballet 3 Question Title * 6. Release of Liability - I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of dance. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/ or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to Showcase Dance Studio, it’s owners, employees, instructors, and all affiliated entities (hereinafter collectively referred to as “Showcase Dance Studio”. I hereby agree to release Showcase Dance Studio and hold Showcase Dance Studio harmless of all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in dance on behalf of the participant. I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I also give Showcase Dance Studio permission to use mine and my child’s picture in or on any form of advertisement for Showcase Dance Studio or a Showcase Dance Studio affiliated event. If I am a minor, my parent and / or legal guardian has also signed this document releasing Showcase Dance Studio from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity. The participant has my permission to participate in Showcase Dance Studio Classes. I warrant the below information is complete and correct. I further release Showcase Dance Studio of all liabilities associated with my child’s attendance at Showcase Dance Studio. Agree Question Title * 7. Comments/Questions Done