Discover & Demo Adaptive Dance Registration Form

Please submit this form with all suplimental documentation to register for this introductory class!

Note: Enrollment is limited to 10 children. As a result, spaces will be available on a 1st come 1st served basis. Registrants can only be considered registered when ALL required documentation has been provided. Every child is required to be accompanied in this class by an adult at a ratio of 1:1 to ensure the safety of all participants.

Please fill out 1 Registration form per child.

Waiver of Liability

• I, the Participant and Parent/Guardian, desire to take part in Kapable x Dance Studio One Dance Lessons conducted at their Dance Studio at . I am aware that engaging in these activities carries inherent risks, including the potential for physical harm, loss of life, or damage to property. I acknowledge and consent that I/my child have/has chosen to participate willingly, understanding the associated risks. I confirm that neither I nor my child have any known physical or medical conditions that would impede our ability to take part and have provided a medical letter of permission from my child's pediatrician confirming this information. Furthermore, I confirm that I will be an active participant with my child in this lesson at a 1:1 parent/child ratio to ensure proper safety of all participants at all times.

  In exchange for the privilege of participating in the aforementioned activities, I hereby release and absolve Kapable, NoMo Worries, Studio One Dance, along with all of their employees, volunteers, officers, and representatives ("Releasees"), from any and all claims concerning personal injury, death, or property damage that may arise due to or in connection with my/my child's involvement in these activities. This release of liability shall not apply in situations where such harm is the direct result of intentional misconduct or severe negligence on the part of the Releasees.

• I acknowledge that photographs or images of myself/my child may be taken during the activity. I provide Kapable & NoMo Worries, along with their agents and affiliates, with unrestricted permission to utilize my/my child's name, photographs, or any other documentation of our participation in this activity in any form of broadcast, telecast, or other reports related to the activity for promotional purposes, without any compensation. I signify my consent by signing below.

  
  

•  Assumption of Risk and Photo Release

 Medical Emergencies

If necessary I authorize Studio One Dance, LLC to administer first aid treatment and/or emergency treatment for the above student on my behalf.

• By Signing this waiver, I affirm that I have read and understand it and agree with its contents.

Medical Emergencies

If necessary I authorize Studio One Dance, LLC to administer first aid treatment and/or emergency treatment for the above student on my behalf.

As the minor’s parent/guardian, I hereby consent to his/her participation in the activity. If my child is injured or becomes ill and neither I nor the other parent/guardian can be reached at the numbers below, I give the Kapable/No Mo Worries/Studio One Dance permission to seek medical attention for my child.

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