R&R Dance Theatre Online Registration

Registration

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Welcome to the R&R Dance Theatre registration page! Please enter all of your information to create an account for your family. The email you input will become your login and will also be the email address that RRDT uses to contact you during the year. Please be sure to keep email address updated. After completing the form you will be able to enroll your child in classes offered per their age group. Registration fee: $45/student (rate is discounted for multiple students per family).

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Name & Phone Number<br/>(Not Contact #1 or #2)*

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Please choose the classes available per your child's age group.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Please choose the classes available per your child's age group.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Please choose the classes available per your child's age group.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Please choose the classes available per your child's age group.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School*

Grade Level*

Transportation

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Please choose the classes available per your child's age group.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Waiver of Liability

I AGREE to the physical nature of dance and to use its equipment and facilities, I the adult applicant, parent or legal guardian hereby release, waive and hold harmless, R&R Dance Theatre, R&R Dance Theatre, R&R Studios, KDI Rivergate Mall LLC, Hendon Properties LLC, Hendon Property Management LLC, Instructors, participants, facility use, its agents, owners, shareholders, directors, partners, employees, volunteers, manufacturers, lessors, affiliates, its subsidiaries, related and affiliated entities, successors and assigns (the "RELEASED PARTIES"•), and any persons involved in the operation of R&R Dance Theatre programs for any claims arising out of injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or spectator for any liability due to accidents, injuries, rigorous activity, exercise or any physical contact with other students which may occur with R&R Dance Theatre Organization, whether it happen in, before, or after class, in performance, and/or in an alternative space.On behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in Rhythm & Revue Dance Theatre trampoline, tumbling & Acrobatics participation entail known and unknown risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: trampoline, tumbling & Acrobatics entails certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Trampoline, tumbling & Acrobatics exposes its participants to the usual risk of cuts and bruises. Other more serious risks exist as well. Participants often fall off equipment, sprain or break wrists and ankles, and can suffer more serious injuries as well. Traveling to and from trampoline location raises the possibility of any manner of transportation accidents. Double bouncing, more than one person per trampoline, can create a rebound effect causing serious injury.
risk.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to defend, indemnify and hold harmless RELEASED PARTIES from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Rhythm and Revue Dance Theatre equipment or facilities, including any such claims which allege negligent acts or omissions of RELEASED PARTIES.

4. Should Rhythm & Revue Dance Theatre or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage that I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition that I may have.

6. I agree that if the participant is a minor, this Release of Liability and Assumption of Risk agreement is made on behalf of that minor participant and that all of the releases, waivers and promises herein are binding on that minor participant. I represent that I have full authority as Parent or Legal Guardian to bind the minor participant to this agreement.

7. I agree that if the participant is a minor, I further agree to defend, indemnify and hold harmless Rhythm and Revue Dance Theatre from any and all claims or suits for personal injury, property damage or otherwise which are brought by, or on behalf of the minor, and which are in any way connected with such use or participation by the minor, including injuries or damages caused by the negligence of RELEASED PARTIES, except injuries or damages caused by the sole negligence or willful misconduct of the party seeking indemnity.

By signing this document, I acknowledge that if anyone is hurt or property damaged during my participation in this activity, I may be found by a court of law to have waived my or the minor participant's right to maintain a lawsuit against Rhythm and Revue Dance Theatre or any RELEASED PARTIES on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. I give my approval and I am fully aware of the personal medical conditions of the student and hereby certify that he/she is physically capable to participate in any of R&R Dance Theatre activities and programs registered for. TO ALL OF THE ABOVE