DanceArts Greenville

Name*

First Last

Name Dancer Would Like to Go By

Age*

Birthday*

Email Address*

Primary Phone Number*

Secondary Phone Number

Address*

Street Address Address Line 2 City State ZIP Code

Adult Dance Classes

Adult Dance Tuition Options*

I will pay for classes at the drop in rate in the DAG office.
I would like to purchase an adult class card for $150.

Adult Class Card*

Price: $150.00

Service Fee*

Price: $5.00

Tuition Total

$0.00

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Medical Release Form

Questions from here on are about medical information. Medical information will be kept private and confidential.

Name*

First Last

Are you physically fit to study dance?*

Yes
No

Do you have any known allergies?*

Yes
No

What Allergies?*

Is the dancer currently taking medication?*

Yes
No

What Medication?*

Please describe any medical conditions we should be aware of.

Assumption of Risk & Waiver relating to Covid-19

Assumption of Risk and Waiver of Liability relating to Coronavirus/COVID-19: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing. DanceArts Greenville has put in place preventative measures to reduce the spread of COVID-19; however, DanceArts Greenville cannot guarantee that you or your child will not become infected with COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected by COVID-19 by attending DanceArts Greenville and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including but not limited to, DanceArts Greenville, participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind. On my behalf, and on behalf of my child, I hereby release, covenant not to sue DanceArts Greenville, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of DanceArts Greenville and its employees whether a COVID-19 infection occurs before, during, or after participation in any dance class/program.

Digital Signature for Assumption of Risk and waiver of Liability relating to Covid-19 (Type your full name.)*

First Last

I [Applicant's Name] understand that dance involves physical contact between dancers, that serious accidents occasionally occur during such activities, and that participants in such activities occasionally sustain serious personal injuries (including death) and/or property damage as a consequence thereof. Knowing the risks of participation, I hereby agree and I assume those risks and release and hold harmless DanceArts and its agents, sponsors and employees who (through negligence or carelessness) might otherwise be liable to me for damages. I agree that I will not make a claim against, sue personal injury or property damages, which I may sustain as a result of my participation in these activities.

I attest that I am eighteen years old or older, and that I have known medical conditions, which prohibit participation in this activity. I agree to follow all laws, rules and guidelines regulating the conduct of DanceArts dancers.

I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability from myself and DanceArts and its agent’s sponsors and employees, and I have signed it of my own free will.

Digital Signature for Medical Release (Type your full name.)*

Date of Application*

Adult Class Registration

Medical Release Form

Assumption of Risk & Waiver relating to Covid-19

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