Sign Up KIDS POP - Atlantis Talent Studio

PERSONAL INFORMATION

Student Name *

First

Last

Date of Birth *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mother's Name *

First

Last

Mother's Phone *

Email *

Father's Name *

First

Last

Father's Phone *

Email *

General Health

Do you have any medical conditions? *

Please list all medical conditions:

Did you attend previously any Dance / Gymnastics programs? *

Check the box for the program you are interested in : *

Kids Pop beginner
Kids Pop Intermediate
Kids Pop for boys

Waiver and Release Form *

I acknowledge the nature of this Activity and that I and (if participating) my child or ward am/is qualified, in good health, and in proper physical condition to participate in Atlantis Talent Studio activities.
I understand that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity. I fully understand that this activity involves risks of any injury, including permanent disability, paralysis and even death, which may be caused by my own actions, or inaction, those of others participating in the event, the conditions in which the event takes place, or the negligence of the school/gym, its employees or agents named below, and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume on my own and/or my child's or ward's behalf all such risks and responsibility for losses, cost, and damages I or my child or ward incur as a result of participation in the Activity. The terms hereof serve as a release and assumption of risk for my heirs, estate, and for all members of my family.
I hereby give permission for certified and licensed medical personnel to use appropriate procedures to aid me, my child, or ward and prevent further injury and/or death. If possible, I wish to be contacted before any procedures are initiated, however, if the injures are catastrophic, life-threatening or I am unable to be reached, I give permission to the emergency care physicians, support personnel, and Atlantis Talent Studio to do what they deem necessary in the best interests of me, my child or ward.
I hereby release, discharge and covenant on my own and/or my child's or ward's behalf not to sue Atlantis Talent Studio, its respective administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) from all liability, claims, demands, losses or damages, on my account caused or alleged to be caused in whole or part by the negligence of the "releasees" or otherwise, including negligent rescue operations and further agree that if, despite this release, waiver of liability, and assumption of risk I, my child or ward, makes claim against any of the Releasees I, and on behalf of my child or ward, will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may occur in the result of such claim. Atlantis Talent Studio reserves the right to use any video or photographic material for any legal purpose.
I further acknowledge, understand and agree that my participation may result in possible exposure to an illness from infectious diseases. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees from others, and assume full responsibility for my participation and exposure.
I have read the Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement, understand that I, my child and/or ward, have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

Photo and Video Release form *

I agree that Atlantis Talent Studio, its administrators, directors, employees have the right to record, broadcast, promote and otherwise exploit in any and all media Participant's activity/performance in the event, and to use Participant's name, likeness, voice, and biographical information in connection therewith.

Rules & Policy *

Annual Membership: $100 Club annual membership is due by September 1st of each year or 1st day of the program start. It includes practice insurance, gym equipment and administrative cost.
Tuition Fees: Tuition is based on 4 weeks program. Classes tuition is due in full on the 29th of each month before the beginning of the next practice session.
Late Payments: There is $30 late fee that will be added to any of late payments including Monthly Tuitions, Private lessons, Competition registrations, coach fees and travel fees.
Gym Rules: No parents on the main floor, No Outside shoes inside,  bring clean dance sneakers,  No food, Only Water is allowed during the practice. Parents must arrive for kids pick up 5 min before the end of the practice.
Private lessons : All scheduled private lessons must be paid in advance before the actual class. Cancellation policy is 24h in advance. If no show or less than 24h notice full amount will be charged.

Appearance: *

Hair must be put up away / in a ponytail for each class
Dress code is a T-shirt with pants or legging 
Wear comfortable clean sneakers, no outside shoes
Bring a bottle of water to each practice

I AGREE TO ALL OF THE ABOVE *

FIRST AND LAST NAME

Date / Time

Date

Time

Signature