Master Class Intensive Week August 10 th 14 th $400/wk - $90/day - $45 class drop in $185-Ballet Classes Only $225-NonBallet Classes Only

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1 DANCE DIMENSIONS PAC 2015 MASTER CLASS INTENSIVE REGISTRATION DANCE (3262) Fax: PLEASE FILL OUT COMPLETELY! Today s Date: _ Student s Name (Please print) Age: Date of Birth: Parents Names Home Address City Zip Home Phone Number Work Phone Number PARENT Cell Phone Number Emergency Contact Primary Phone Number Secondary Phone Number School District Address (Very Important!) How did you find out about Dance Dimensions? Master Class Intensive Week August 10 th 14 th $400/wk - $90/day - $45 class drop in $185-Ballet Classes Only $225-NonBallet Classes Only First Class each day 4:30pm to 6:00pm Second Class each day 6:30pm to 8:00pm Check desired attendance-full week or Single days: Check Attending: Instructors: Here Full Week Monday Tuesday Wednesday Thursday Friday Kyle Hanagami Hip Hop Dejan Tubic Hip Hop Katee Shean Contemporary Travis Wall Contemporary Travis Wall - Jazz 1

2 MEDICAL RELEASE I am a current 2014/2015 DD student: use my Medical Information on file. I, authorize Dance Dimensions Performing Arts Center to provide any attention necessary to my dancer,, in the event of a medical emergency, including but not limited to ice, bandages, Tylenol and transportation to a medical facility, if needed. Insurance Company Doctor s Name Doctor s Phone Number Allergies Date of last Tetanus shot _ Does your child have any current medical conditions? Print your name Relationship to dancer Signature Tuition Cost to be charged $ CREDIT CARD AUTHORIZATION USE CREDIT CARD ON FILE? Payment Type (circle one): Visa Mastercard NO CHECKS! Cardholder s Name: Card # Expiration Date CVC code (3 numbers) Address where credit card is billed Zip Cardholder Signature Date 2

3 DANCE DIMENSIONS PERFORMING ARTS CENTER POLICY ACKNOWLEGEMENT Credit Card and cash only. No checks. 5% Sibling discount There are no refunds or makeups for missed Intensive classes All payments and fees are non-transferable and non-refundable Studio is not responsible for lost or stolen items. Please do not bring anything of value to the studio. Dance Dimensions reserves the right to change the schedule and/or cancel classes at any time. All classes and programs are subject to change and/or cancellation. Dance Dimensions is not responsible for students who leave the facility without supervision or permission form. Make sure to submit form found in this Registration Packet. Dance Dimensions reserves the right to dismiss or refuse classes to anyone who does not comply with policies or who otherwise in our sole judgment disrupts the harmony and/or reputation of studio. Please do not ask to be the exception to any of the studio policies! By initialing the statements below, I agree that I have read, understand and will abide by Dance Dimensions policies. Initial each of the following summary statements, and sign and date at bottom. Summer Intensive is non-refundable. There are no refunds, credits, or extensions given For missed classes. Dance Dimensions does not prorate for absences or vacation time. Dance Dimensions reserves the right to change or cancel classes at any time. Respectful behavior is expected at all times towards Dance Dimensions staff and fellow students. No food or drink allowed in the studios. Please eat snacks or lunches in the kitchen or in designated areas. Do not bring cell phones or gum into the studios. Dance Dimensions is not responsible for lost or stolen articles. Dance Dimensions assumes no liability for any injury sustained while participating in dance classes or any other studio activity, either at DDPAC or away. I release Dance Dimensions Performing Arts Center, its staff, management, owners, contractors and volunteers from any liability due to injury. Dance Dimensions reserves the right to dismiss or refuse classes to anyone who does not comply with our policies or who otherwise in our sole judgment disrupts the harmony and/or reputation of the studio. _ Parent s Signature Date _ Student s signature 3

4 DANCE DIMENSIONS PERFORMING ARTS CENTER WAIVER OF LIABILITY READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. BY SIGNING THIS DOCUMENT YOU ARE LIMITING YOUR LEGAL RIGHTS. NAME OF PARTICIPANT This Release and Waiver of Liability is executed on this date of, 2015, by: if over 18) or If the participant is a minor, this document is to be signed by the minor s legal guardian (parent). By signing below, minor's legal guardian indicates that he or she understands that the use of I below refers to both the legal guardian and minor. I wish to participate in a dance class, rehearsal, dance party or other activity at Dance Dimensions Performing Arts Center (hereafter known as DDPAC ), either as part of DDPAC s programming or as a participant of a private studio rental of DDPAC facilities. As a condition of DDPAC agreeing to allow me to participate in such an activity, I hereby confirm and agree to the following: 1. I recognize that the activity of the type I intend to participate in at DDPAC requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in any activity I attend at DDPAC. I represent that I am physically fit and have no medical condition that would prevent my full participation in any such activity. 3. I understand that DDPAC is not liable for any injuries to any participant, dependent(s) or guest(s) or be subject to any claim or demand for injury or damages whatsoever, including, without limitation, those damages resulting from acts or negligence on the part of DDPAC, its owners, agents, instructors or employees. I, and on behalf of my executors, administrators, heirs, assignees and successors, do hereby knowingly and voluntarily forever waive, release, discharge and agree to indemnify and hold harmless DDPAC, its owners, instructors, employees, assignees and successors from all such claims, demands, injuries, damages, actions or causes of action for any injury or damage that I may sustain as a result of my participation in an activity anywhere within the confines of DDPAC. 4. DDPAC shall not be responsible to me, my dependents or guests for property damaged, lost or stolen in or surrounding DDPAC confines, including but not limited to clothing, cellphones, cash, credit cards, jewelry and any and all personal property brought to and/or left at DDPAC. 5. I agree to take full responsibility for any risks, injuries, loss or damages known or unknown which I incur, or may incur, as a result of participation in any activity at DDPAC. I DECLARE that I have fully read and understand this waiver and release prior to signing. I understand that I am waiving any right I may have to assert a claim against the Released Parties. X Date Dancer/Participant s Signature Age of Minor Print Name of Responsible Party X Date Responsible Party Signature 4

5 PARENTAL PERMISSION FOR STUDENT TO LEAVE DANCE DIMENSIONS PERFORMING ARTS CENTER DURING CLASS HOURS Dance Dimensions Performing Arts Center is located within Westfield s Promenade Mall in Woodland Hills. The Mall also contains restaurants, a bookstore, food court with sitting area, movie theatres and other shops. Our policies state that Dance Dimensions students under the age of 18 may not leave our premises without supervision. However, students may do so with the following written permission from their parent or guardian. By signing below, you are releasing Dance Dimensions Performing Arts Center, LLC, its owners, managers, teachers and employees from supervising your dancer during the time he/she is out of our doors. You agree that once out of our doors, the health, safety and fiscal responsibility of your dancer is yours. Understand that if your dancer does not return from the Mall for dance classes in a timely manner, you are still financially liable for those classes. Please choose one section, check box and complete: My student, (name) MAY NOT leave Dance Dimensions premises during class hours. Signed Date Print your name and relationship to student: OR My student, (name) MAY leave Dance Dimensions premises during class hours. I,, as the (circle one:) father / mother / guardian of (Student name), age, give permission for my child to leave Dance Dimensions premises during class hours between August 10, 2015 and August 14, I understand that I am responsible for their safety during these times and that my child may sign out when leaving the studio and sign in upon return. Parent Signature Date Student Signature _ Date Parent Cell Phone Number or Dancer Cell Phone Number 5

CLOSED FOR MEMORIAL DAY WEEKEND

**CLOSED FOR MEMORIAL DAY WEEKEND** DANCE DIMENSIONS PAC 2016 BALLROOM DANCE REGISTRATION 818-999-DANCE (3262) Fax: 818-999-5298 PLEASE FILL OUT COMPLETELY! Today s Date: _ Student s Name (Please Print) Age: Date of Birth: Parents Names