IN-HOUSE PRIVATE LESSONS REGISTRATION FORM

Dancers Name *

First Name

Last Name

Parent/ Guardian Name *

First Name

Last Name

Cell Number *

(###)

###

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Home Number

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Chosen Instructor & Discipline *

You can pick multiple sessions/ instructors on one form.

RAD Ballet (Kirsten)

Jazz technique/ jumps/ turns/ tricks (Brianna)

Jazz strength & flexibility (Brianna)

Acro skills (Dayton)

Hip Hop (Dayton)

Ballet Technique (Kirsten)

Solo Private or Shared Private? *

Dancers who wish to join another dancer for a private lesson must arrange this themselves with a fellow student who is studying the same grade as them. Maximum - 2 dancers per session. A shared private will only be accepted when a registration form is received from both parties.

Solo Private

Shared Private

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

Covid-19 Waiver *

The MEMBER/ PARENT/ GUARDIAN waives and releases Studio G Dance Academy Ltd; any program; and it’s employees from any and all claims for the risk of being exposed to and/ or contracting COVID-19 while participating in any program, and/or while waiting unsupervised before and after class and/ or entering the studio premises. The MEMBER/ PARENT/ GUARDIAN has read the website/ brochure/ registration details and accepts all policies. By checking the box the dancers PARENT/ GUARDIAN/ reads and agrees to the COVID-19 waiver. See waiver release form attached at the bottom of the registration form.

Agree