Dancer's Name *

First Name

Last Name

Dancer's Gender *

Female

Male

Medical Emergency Authorization: If your child is need of immediate medical attention due to illness or an accident, it is necessary for the staff to take appropriate action on behalf of your child. By checking the "agree" box, you are giving consent for the following: I give permission for the staff/ volunteers at Studio G Dance Academy Ltd to call a medical practitioner or ambulance for my child in the event of illness/ accident is to occur on-sight or at an off-sight event/ program/ activity. I agree that I shall be solely responsible for any cost incurred for such services. *

Agree

Parent/ Guardian Name *

First Name

Last Name

Cell Number *

(###)

###

####

Home Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Photos *

I agree for my dancer's photo to be taken and allow SGDA to use the images for advertising purposes on posters/brochures/ websites/ social media/ studio notice board.

Yes

No

Participation Waiver *

We require that the dancers PARENT/ GUARDIAN/ reads and agrees to the following waiver: The MEMBER/ PARENT/ GUARDIAN waives and releases Studio G Dance Academy; any program; and it’s employees from any and all claims for personal injury arising during the participation in any program, and/ or while waiting unsupervised before and after class. The MEMBER/ PARENT/ GUARDIAN has read the website/ brochure/ registration details and accepts all policies posted on studiogdanceacademy.com.

Agree