Student Name
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First Name
Last Name
Parent/Guardian Name
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First Name
Last Name
Student Date Of Birth
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Student Current Age
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone Number
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(###)
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Email
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Message
Choose a Week or Weeks
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Summer Camp Policies
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MUST READ BEFORE REGISTERING!
ALL OF THESE POLICIES ARE ENFORCED. PLEASE DO NOT EMAIL ASKING OTHERWISE.
1. After you register you MUST make a full payment OR a deposit of $150.00, for each week you are registering for, otherwise, your registration is void. If you choose to make a deposit we will email you and set you up with a monthly payment plan.
2. Absolutely NO switching from full day to half day; NO switching from one week to another once you’ve registered.
3. Absolutely NO REFUNDS, NO CREDIT, NO EXCHANGES once you have registered - unless its for medical reasons with a doctor's note.
Medical Release
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Medical Release and Authorization: As legal guardian of the child listed on this form I hereby consent for him/her to participate in classes conducted by the Children’s Ballet & Movement Co. Recognizing that any activity involving movement can create the possibility of injury. I will not hold any personnel, officers, agents or instructors liable for any injury that may occur before, during and after class or on the Children’s Ballet & Movement Co. premises. I confirm that my child is in good health and I authorize simple first aid if necessary. I also understand that I am fully responsible for the total tuition session I registered for unless my child is unable to participate for medical reasons. In which case I will provide a signed medical notice from his/ her doctor.
COVID-19 Waiver
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I knowingly and willingly consent to have my child participate in programs with The Children’s Ballet & Movement Co. during the global COVID-19 pandemic. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show signs and symptoms and still be highly contagious. It is impossible to determine who has it and who does not with the current limits in virus testing.
By sending my child to dance, I confirm that my child and members of my household have not in the past 14 days had any of the following symptoms of COVID-19 listed below:
-Fever greater than 100.4 degrees Fahrenheit
-Cough
-Shortness of Breath
-Flu like symptoms including GI upset, fatigue, body aches, or muscle pain
-Chills or repeated shaking with chills
-SoreThroat
-Headache
-Sudden loss of taste or smell
By sending my child to dance I further confirm that he/she has not been exposed to a person under investigation for COVID-19, or a person diagnosed with COVID-19, in 14 days prior to any dance class attended.
I understand that certain travel may increases risk of contracting and transmitting the COVID-19 virus. In addition, the CDC recommends quarantine of 14 days. Therefore, I verify that my child, nor anyone in my household, have not traveled outside the United States in the past 14-days to countries that have been affected by COVID-19.
I will hold harmless and indemnify, The Children’s Ballet & Movement Co., teachers, associates, and employees against any claims, and actions, in exchange for programs with The Children's Ballet & Movement Co. during this Covid-19 pandemic. Please be advised that there may be risks with being in the proximity of other people. We are taking precautions to limit the spread of the disease, and following Massachusetts Reopening: Mandatory Safety Standards for Workplaces, yet there is still possibility for transmission. I make this decision for my child of my own free will relying upon my knowledge and judgement of any injury they may have sustained or possible illness, including the transmission of COVID-19, during participation in programs, and my decision to release has not been affected by any false statements or representations pertaining to those injuries or illnesses. I understand that this action is my decision. PLEASE do not send your child to the studio if they, or any member of your household, are experiencing any of the signs and symptoms of COVID-19, as outlined above. This COVID-19 screening and consent to participate will be used each day programs are held. This written consent will be in effect for future classes and programs, and by sending your child to the studio you are consenting to continued negative responses to COVID-19 signs and symptoms. If your child or someone in the home has any of the symptoms listed above, they may not attend class at the studio. By sending your child to the studio, you are consenting to this form, and stating your child and any and all members of the home are not exhibiting any of the signs and symptoms of COVID-19, as outlined above, and any and all members of the home have not been exposed to a person under investigation for COVID-19, or a person diagnosed with COVID-19 in the lsat 14 days.
Photo/Audio/Video/Social Media Release Authorization
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Photo/Audio/Video/Social Media Release Authorization: I hereby irrevocably consent to and authorize the reproduction, publication and/any other use by The Children’s Ballet & Movement Co., his/her licensees and assigns, of the photographs/audio/video, in any medium and for any lawful purpose, including illustration, promotions, advertising, social media or web content, without any royalty or compensation to me. I assign to The Children’s Ballet & Movement Co. any and all rights of ownership to the photographs/audio/video, the transparencies or digital files thereof, and agree that The Children’s Ballet & Movement Co. has full right of lawful disposition in any manner. I waive any right to notice, inspection, or approval of any use of the photographs/audio/video which The Children’s Ballet & Movement Co., may make or authorize, and I release The Children’s Ballet & Movement Co., and his/her licenses and assigns, from any claim or liability arising from or in connection with The Children’s Ballet & Movement Co.’s us of the photographs/audio/video or any alteration, processing or use thereof in composite form, whether intentional or otherwise.
CHECK ONLY ONE BOX BELOW.
