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DANCE WORKS STUDIO
awesome tradition!!! awesome fun!!!
*TO REGISTER FOR DANCE PLEASE FILL OUT THE REGISTRATION/WAVIER FORM
AND RETURN IT WITH YOUR FEES
CLASSES START SEPTEMBER 9th
CLASSES START SEPTEMBER 9th
DANCE WORKS STUDIO
P.O. Box 493
Gunnison, Utah 84634
*Please make copies of the registration form if you need to. I will need a separate form for each student. *I will send you your class schedule, day and time etc. and more information when I receive your registration. If you have any questions you can call Mekesha Wanner at (435) 690-9016 or e-mail mewanner23@yahoo.com. You can also check out our blog www.danceworksstudio.blogspot.com or find us on facebook. Thanks for your support! We are excited to have you come and DANCE WITH US!
PERSONAL INFORMATION:
Student’s Name_____________________________ Age_____ DOB__________ School Grade______
Mailing Address___________________________________ City_________________ Zip__________
Parent/Guardian’s Name_______________________________________________________________
Both Parent’s E-Mail Addresses:
_______________________________________/______________________________________________
Home Phone #______________ Mother’s Cell #________________ Father’s Cell #________________
Child’s Cell #___________________________ Child’s E-mail_________________________________
EMERGENCY CONTACT INFO:
Emergency Contact_______________________ Phone ( ) ______________ Cell ( ) ______________
Allergies_______________________________ Special Instructions_____________________________
LIST ANY PREVIOUS EXPERIENCE: ___________________________________________________
WHAT IS THE BEST WAY TO CONTACT YOU (i.e. phone, mail, e-mail)______________________
HOW DID YOU HEAR ABOUT US? _____________________________________________________
CLASS/CLASSES TO REGISTER FOR ___________________________________________________
If Ballroom Dancing – Partners Name________________________________________________
Level (if I don’t already know – i.e. beg./ int./adv.)_____________________________________
Dance Fees- Our dance fees are $25 a month for one class, $45 for 2 classes, and $60 for 3 classes. These rates are for one person taking 1, 2, or 3 classes. Combo classes are $40 for 2 and $45 for 3. Competition classes depend on which team you are on. We also have special family rates. You also have the option to pay the entire year up front with a 10% discount. *There is a costume fee of $35 for girls per class (so if you take clogging & jazz, you would pay $70) and $15 for boys per class. There is also a $5 registration fee per dancer with a $20 max per family.
Acknowledgment of Risks & Hazards, Liability Release & Agreement Not To Sue for:
Dance Works Studio, It’s Owners, Directors and their Successors in Interest, Affiliates, Agents, Landowners, Instructors , Employees, Volunteers and Insurers
PLEASE READ CAREFULLY BEFORE SIGNING, THIS IS A LEGAL DOCUMENT
Before being permitted to participate in Dance/Tumbling programs, please read the following and sign below agreeing to comply with this agreement.
I hereby agree to release Michael & Mekesha Wanner, Dance Works Studio, and any other employees or affiliates of Dance Works Studio and hold them harmless of any and all liability, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for any and all risks of injury resulting from participation in any dance classes at Dance Works Studio. I knowingly and voluntarily assume full responsibility for any and all risks of injury resulting from participation in any dance classes at Dance Works Studio. I knowingly and voluntarily waive all rights and/or causes of action of any kind, including any and all claims of negligence, arising as a result of activity from which liability could accrue to Michael & Mekesha Wanner , Dance Works Studio, and any other employees or affiliates of Dance Works Studio.
I am aware that this is a release of liability and an acknowledgment of my voluntary and knowing assumption of risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation. I hereby certify that I and/or my minor child are physically fit and have no medical conditions or allergies that affect the ability to participate in these activities
If I am a minor, my parent and/or legal guardian has signed this document releasing Michael & Mekesha Wanner and Dance Works Studio and any other employees or affiliates of Dance Works Studio from any and all such liability described above and has acknowledged that I am knowingly and voluntarily assuming all risk of injury inherent to these classes.
First Aid Release:
I authorize Dance Works Studio to administer first aid as they deem necessary. I authorize transportation to a medical facility, at my expense, if deemed necessary by Dance Works Studio's teachers. I understand and accept that minor injuries may become life-threatening emergencies when far away from others or convenient facilities. Further, in the case of serious illness or injury, if I cannot be reached, I give permission for treatment, including medical and/or surgical care necessary for the well-being of myself or my child (hereafter, “minor participant”) at my expense. I understand that the teacher's will, to the best of their ability attempt to notify me as soon as possible in the event of an emergency. I agree that upon transporting myself or my minor participant, to any medical facility, clinic or hospital, the responsibility of the teachers shall be totally fulfilled and Dance Works Studio shall have no further responsibility.
Photographic Release:
I/We consent to the use by Dance Works Studio of any pictures (video and print) for commercial purposes, or otherwise, of me or my minor child in connection with the activities of the Dance Works Studio, without restriction as to frequency, duration or medium.
Payment Terms:
All tuition is due the first lesson of each month to pay for new session forward. You agree to pay all tuition covering classes for which your child is enrolled. No credit will be given for missed classes or nonattendance, except in cases of prolonged injury or illness. Accounts not current by the 10th of the month will be considered past due and a $15 late fee will be added to your bill. If the account is not current by the first lesson of the next month, your child will not be allowed to participate in classes until it is brought up to date. We accept cash or checks (made payable to Dance Works Studio).
____________________________________________________ PARTICIPANT’S SIGNATURE/DATE
____________________________________________________ PARENT/GUARDIAN'S SIGNATURE/DATE
