Registration
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FREE dance clinic's. Held March 26th & 28th from 3:30-5pm at Starz Studio of Performing Arts. Our Clinic registration will close on 3/22/19. For questions call 816-690-7771, Mon-Thurs from 5-8pm. Thank you!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Father
Grandparent
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Parents will check email messages the night prior to each clinic to verify any changes to our events. Check yes to agree please.
*
Yes
No
Participants should attend dressed in sweats or similar with both socks and tennis shoes. Check yes to agree please.
*
Yes
No
Parents MUST collect you children by 5pm after each clinic date. We reserve the right to prevent students from attending future dates if this requirement is not met. Check yes to agree please.
*
Yes
No
Additional Information:
Assumption of Risk
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I agree (if applicant/participant is 18 years of age or older) or parent/guardian of the above listed minor applicant/participant acknowledge and fully understand that each applicant/participant will be engaging in activities that involve risk of serious injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inaction or negligence, but action, inaction or negligence of others, the condition of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time, assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not to sue Starz Studio of Performing Arts Inc, its affiliated organizations and sponsors, their instructors, managers, employees and associated personnel, officers, directors, agents, including the owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees", from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the applicant as a result of the applicant's participation in the programs. I, also agree to save and hold harmless and indemnify each and all parties herein referred to above as release from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said release because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the release.
I've read the above and agree.
Release of Liability
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Parents, legal guardians of minors, students and adult students waive the right to any legal action for injury or damage sustained or resulting from normal dance or tumbling activity or any other activity conducted by the students before, during or after class times while on the property or in the care of employees of Starz Studio of Performing Arts, Inc. or Starz Enterprises, LLC. Starz is not responsible for before or after class care for students. Students are not to be left at the school for excessive periods of time prior to or following their own classes.
I've read the above and agree.
Authorization of Images
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I hereby authorize Starz Studio of Performing Arts, Inc., its affiliated organizations and sponsors (collectively referred to as "Starz"), to use, reproduce, and/or publish photographs and/or video that may pertain to me (if applicant/participant is 18 years of age or older) or my minor child (if applicant is the parent or legal guardian of a participant under the age of 18 years), including my (or my child's) image, likeness and/or voice, without compensation. I understand that this material may be used in various publications, public releases, recruitment materials, any and all forms of advertising, or for other related endeavors. This material may also appear on Starz's Internet Web Page. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, Starz may publish materials, use my (or my child's) name, photograph, and/or make reference to me (or my child) in any manner that Starz deems appropriate in order to promote/publicize Starz.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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