Excel Dance Academy - Adult Class Pass Purchase Form

Class Pass Info:

This pass gives you 8 classes of your choice.

Use the codes to reserve your spot in the classes you wish to attend.

Expire 120 days from purchase date.

You will then be able to register for the individual dates you will be able
to attend. You do not have to register for all the dates at once, but you must
register before noon the day of the class.

Products

Adult Class Pass $99

For hour long classes

Adult Class Pass $134

For hour and a half long classes

Subtotal $0.00

Account Owner/Dancer

First name *

Last name *

Email *

Mobile *

Date of birth *

Address *

City *

Country *

State/Province *

Zip/Postal code *

Medical conditions Show

Allergies Show

Emergency Contact

We will only use this number in the event of a serious emergency, DO NOT put your own contact information.

Relationship

First name *

Last name *

Mobile *

Permission *

Do we have permission in case of an emergency situation to call 911?

Yes No

Advertisment/Marketing *

I give permission for Excel Dance Academy to use video footage and / or photographs of myself. This usage may include (but is not exclusive to) displaying publicly, distributing, or publishing, photographs, and/or video of my child for use in materials that include, but may not be limited to:

- printed materials (ex - brochures and newsletters)
- online and offline advertising and promotion
- videos and digital images such for use on our website or social media.

Yes No

Please respect your studio; place all garbage in the trash cans, pick up your belongings, do not wear street shoes in the studios, keep your change areas and bathrooms tidy. Please be sure to clean up after yourself when you are finished.
Students will not hang on the barres, touch the mirrors or operate the sound systems.
Drinks (other than water bottles with a secure lid) and cell phones are not permitted in class.
Students will not be allowed in any dance studio without a teacher present. This is for your own safety.
Classes must be registered for before noon the day of the class.
The studio is not responsible for any lost or stolen articles. Please leave your valuables at home.
Spectators are not allowed in class.
For safety reasons, no jewelry may be worn in class. Please leave all jewelry at home.
It is important that students come to class dressed in the proper dance attire so body lines are clearly visible to the instructors. This is necessary for proper instruction. You may wear exercise clothing or general ballet attire.
Dancers must have their hair pulled back from their face if long
Students will show the utmost respect to the facility, fellow dancers, parents and staff at all times.
Replacement of any broken items will the responsibility of the student or student's Parent or Guardian.
I hereby release Excel Dance Academy and all staff from all claims of damage or injury suffered by above registered dancer in connection with or association with Excel Dance Academy.
I acknowledge that participation in dance is potentially dangerous and there is an inherent risk of injury involved. In participating in Excel Dance Academy activities, I hereby assume all the risks associated with the performing arts. I understand the importance of following the instructions and rules set the instructor/s, and I agree to release Excel Dance Academy and its employees of any and all liability which may arise as a result of my participation in activities at Excel Dance Academy.

I read and accept *

Please read and scroll to the bottom to accept.

Electronic signature*

Please sign your name inside the box

Draw Type

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