Dancer Information *

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian Information

First Name

Last Name

Phone

(###)

###

####

**Dance Level Selection**
Please select the dance level for each style of dance the dancer is interested in:

Jazz:

Beginner

Intermediate

Advanced

Hip Hop:

Beginner

Intermediate

Advanced

Breakdancing:

Beginner

Intermediate

Advanced

Raub:

Beginner

Intermediate

Advanced

Bats:

Beginner

Intermediate

Advanced

Ballet:

Beginner

Intermediate

Advanced

Contemporary:

Beginner

Intermediate

Advanced

Lyrical:

Beginner

Intermediate

Advanced

**Dance Experience**

How many hours per week does the dancer dance?

0-3 Hours

4-6 Hours

6+ Hours

S28 Productions Hub/Studio 28 LLC

Liability Waiver and Photo Release Agreement

*

Liability Waiver

I, the undersigned, hereby acknowledge and agree that participation in dance and related activities at *S28 Productions Hub/Studio 28 LLC* may involve inherent risks, including but not limited to, physical injury, accidents, falls, or other hazards. I understand that these activities require a certain level of physical fitness and coordination, and I assume full responsibility for any personal injury, property damage, or other losses that may occur during participation. By signing below, I voluntarily agree to: 1. **Release and Discharge** *S28 Productions Hub/Studio 28 LLC*, its owners, directors, instructors, employees, and affiliates from any and all liability, claims, demands, or actions that may arise from injuries or damages sustained while participating in dance classes, rehearsals, performances, or any related activities, whether caused by negligence or otherwise. 2. **Indemnify and Hold Harmless** *S28 Productions Hub/Studio 28 LLC* from any claims, costs, expenses, or damages arising from participation in these activities. I certify that I/my child is in good physical health and able to safely participate in the activities provided by *S28 Productions Hub/Studio 28 LLC*. I agree to abide by the rules, policies, and guidelines of the studio and understand that failure to do so may result in dismissal from the program without a refund.

Participant Name

First Name

Last Name

Parent/Guardian Name (if participant is a minor):

First Name

Last Name

Phone:

(###)

###

####

Emergency Contact

*

First Name

Last Name

Date:

MM

DD

YYYY