Aria Dance Academy - Movie Night Registration

ARIA MOVIE NIGHT REGISTRATION FORM

PARTICIPANT'S INFORMATION

First name *

Last name *

Gender * Please specify

Date of birth *

PARENT / GUARDIAN'S INFORMATION

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile *

Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Other Phone #:

Emergency Contacts

Please add at least one person who lives outside of your household.

First name *

Last name *

Email *

Mobile *

“R e l e a s e o f L i a b i l i t y W a i v e r”

I, the participant, or parent / legal guardian of the designated above-named participant, acknowledge that participation in dance classes, rehearsals, performances, and related activities at Aria Dance Academy LLC involves inherent risks, including but not limited to physical and emotional injury, falls, sprains, strains, and other potential hazards. I recognize that severe injuries can occur in any activity involving height or motion, including dancing, stretching, conditioning, tumbling, and physical activity in general.

I understand that it is the expressed intent of all Aria Dance Academy LLC staff and personnel to provide for the safety and protection of myself or the above-named participant(s) and in consideration for using these facilities, or allowing the above-named participant(s) to use these facilities, I hereby voluntarily COVENANT NOT TO SUE and FOREVER RELEASE Aria Dance Academy LLC, this facility, affiliated and partner companies and organizations, property owners and lessors, staff, contractors,
subcontractors, teachers, coaches, owners, directors and other members involved in this facility's program(s), from all liability and for any and all damages and injuries suffered by myself or the above-named participant(s) during instruction, supervision, and/or control during any and all classes or extra activities, whether caused by negligence or otherwise.

MEDICAL AUTHORIZATION: In the event of an injury or medical emergency, I authorize Aria Dance Academy LLC and its staff to seek medical treatment for myself or the above-named participant(s) at my expense. I understand that I am responsible for any medical costs incurred as a result of participation.

ACKNOWLEDGMENT: By clicking below, I confirm that I have read, understood, and agree to the terms outlined in this Release of Liability Waiver.

I have read and accept *

Please read and scroll to the bottom to accept.

Photo & Video Release *

"P h o t o & V i d e o R e l e a s e"

I grant permission for Aria Dance Academy LLC to use photos and videos of myself or my child for promotional purposes, including but not limited to social media postings and advertisements, online websites and channels, and marketing materials.

Yes No x Clear

Parent/Guardian signature

(for Students Under the Age of Majority)

Type your name

Signature style

Parent/Guardian signature Signature pad

Movie Night Ticket

Item

Item 1

Price

$30.00

Amount

$0.00

Subtotal $0.00

A required field has not been filled.

Please accept all conditions.

Connect to fill this form

Please type in your email or mobile number. We will send you a connection code.

Email or mobile

Connection code

Waitlist

Leave us your coordinates. We will contact you when a spot frees up.

Comment

Please wait...

Membership

Your membership is tied to your email address. If you are using the wrong email, your membership will not be detected. You can try disconnecting and connecting using another email address.

If you need further assistance, please write to info@activitymessenger.com. Please include a screen capture if possible.