Ta-Dah Dance Academy - Albemarle, NC

Registration

Dancer/Participant Information:

First Name Last Name

Date of Birth (00/00/00) Age

Address City State Zip

Home Phone Cell Phone Email Address

Academic school dancer attends Grade

Mother/Guardian Information:

First Name Last Name Employer

Home Phone Cell Phone Work Phone

Email Address

Father/Guardian Information:

First Name Last Name Employer

Home Phone Cell Phone Work Phone

Email Address

What type of dance classes have you taken?

Please list the classes that you or your child is interested in:

How did you hear about Ta-dah Dance Academy?

Pertinent Medical Information:

Are there any physical problems, allergies (including food or drug), asthma, previous injuries, or
special needs that Ta-dah Dance Academy should be aware of? YES NO

If yes, please describe:

Is the participant taking any medication on a daily or regular basis? YES NO

Authorization to Consent to Emergency Treatment:

In the event of an emergency, illness, or accident and you cannot be reached, please list the names and numbers of the persons you are authorizing Ta-dah Dance Academy to contact:

Physician Name Phone #

I authorize Ta-dah Dance Academy’s instructors or staff to administer first aid and to obtain medical care for my child, in the event of an accident or injury. YES NO

Liability Disclaimer: I for myself and/or my minor child release and forever discharge and agree to hold harmless Ta-dah Dance Academy and any of it sub-contractors for any liability, claims or demands for personal injuries, sickness, or death, as well as for expenses due to loss or damage to personal property and lost wages. Since dance is a physical activity, injuries may occur. Each student/guardian has the right to decline participation in any activity which they are not comfortable with or which they feel may be harmful. Each student/guardian is alo responsible for informing instructors of any physical limitation which may prevent full participation in class. It is required that all students be covered by their family’s insurance. If injury occurs, it is understood that the student’s own policy is the only source of reimbursement. Additionally, Ta-dah Dance Academy has permission to use photos/videos taken of the above signed student for any advertising and promotions.

By clicking the submit button below, you agree to all studio policies and terms listed above.