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GBAD Registration Form 2016/2017


Waiver of Liability

Great Bay Academy of Dance is not responsible for belongings left in the studio. Students dance at their own risk. We cannot be held liable for any injuries incurred to students and/or parents during classes or while on school premises. I agree that I will not hold Great Bay Academy of Dance, its owners, agents, and. or employees liable for any of the above circumstances.


Student Information


Student Name:

Student D.O.B.:

Age as of 9/8/16:

Mailing Address:

City:

State:

Zip:


Home Phone #:

Student's Academic School:

Student's Email (optional):

Student's Cell Phone # (optional):

Student's Allergies:

Student's Medical Condition(s):

Emergency Contact Name:

Emergency Contact Number:

Parent/Guardian Information

(adult students, simply type N/A)



Parent/Guardian #1


Parent/Guardian Name:

Parent/Guardian Cell Phone:

Parent/Guardian Employer:

Parent/Guardian Email:



Parent/Guardian #2 (optional)



Parent/Guardian Name:

Parent/Guardian Cell Phone:

Parent/Guardian Employer:

Parent/Guardian Email:


Payment Information

(please see the GBAD Student/Parent Handbook for more information)





Class Choices


(Please list the class, time and day for each class selected)


GBAD Participation Contract


By providing a check in the boxes below means that you understand and are signing this electronic agreement:

Liability Waiver

I/we realize that participation in dance classes and other physical activities could involve possible personal injury. Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Great Bay Academy of Dance, LLC.

I/we agree to release and hold harmless Great Bay Academy of Dance, LLC including its teachers, dancers, staff members, and facilities used by Great Bay Academy of Dance, LLC from any cause of action, claims, or demands now and in the future. I/we will not hold Great Bay Academy of Dance, LLC liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes or performances.

Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Great Bay Academy of Dance, LLC and all material outlined in the GBAD Family Handbook.

I/we understand that Great Bay Academy of Dance, LLC is an insured organization. In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our classes or performances, I/we agree to report the unsafe conduct or conditions to the Academy Administrator, Artistic Director, instructors or staff members as soon as possible.


Financial Responsibility

Class space is reserved for you and tuition will continue to be charged until GBAD receives proper written notification directly from the student’s Parent or legal Guardian. If written notification for withdrawals is received after the aforementioned dates in the Student/Parent Handbook, then Parent or legal Guardian will not receive any tuition back. Parents and legal guardians are responsible for all tuition payments, balances including outstanding balances as well as costume fees associated with participation.


I/We have reviewed GBAD’s Student/Parent Handbook and understand the policies outlined within. By signing, I/We agree to adhere to GBAD’s policies.


Photography Release

I give permission for images of my child to be used by GBAD for promotional purposes, press releases as well as the GBAD website. GBAD will not associate a child’s name with photos without seeking additional permissions.


Please Type Your Name:

Date:

How did you hear about GBAD?