Dancer Name *

First Name

Last Name

Dancer Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Classes *

Please indicate which classes the dancer is registering for.

Thursday Beginning Ballet

Tuesday Intermediate Ballet

Thursday Intermediate Ballet

Monday PreProfessional Ballet

Wednesday PreProfessional Ballet

Friday PreProfessional Ballet

Tuesday Adult Ballet

Friday Adult Ballet

Tuesday Intermediate Pointe

Monday Advanced Pointe

Wednesday Advanced Pointe

Emergency Contact #1 Name *

First Name

Last Name

Emergency Contact #1 Phone *

(###)

###

####

Emergency Contact #2 Name

First Name

Last Name

Emergency Contact #2 Phone

(###)

###

####

Assumption of Risk *

I do hereby assume full responsibility for any and all damages, injuries, or losses that I/we may sustain or incur, if any, while attending or participating in any Myers program and/or during any visit to Myers Studio. I/we hereby waive all claims against the Myers Studio, its instructors, agents, staff or partners of said studio, individually, or otherwise, for any and all claims for injuries or damages that I/we might sustain. I understand that there is a risk of injury associated with participation in any Myers Studio program and I/we certify that I/we are in good physical condition and have no disabilities or other ailments that may hamper my/our participation. I certify that all of the information provided on this document is correct and true.

I have read, understood, and agree with the above statement.

Photo and Video Release *

I hereby grant to Myers Studio, and their respective licensees, successors and assigns, the right and permission, with respect to photographs and videos taken of me or the minor named below on whose behalf I am signing, and with respect to any printed matter in connection therewith, to do the following: 1. To include such photographs and videos in all media, and in advertising, publicity and promotion thereof. 2. To use my name or the name of the minor on whose behalf I am signing, in connection with the foregoing. I hereby release, discharge and agree to indemnify and hold harmless Myers Studio and their respective heirs, legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same.

I have read, understood and agree with the above statement.

Tuition Policy *

One tuition fee will be charged for the Summer term. Fees are to be paid (in full) by their respective due date. By checking below you acknowledge that you are responsible for payments and will pay payments on time. New families will be charged an additional one-time $30.00 registration fee. Families with an outstanding balance at the start date of classes will not be allowed to participate in class until tuition has been paid. Additionally, owed tuition not paid before the start of summer term will accrue at $25 per week late fee until all tuition and fees have been paid in full.

I have read, understood and agree to the above statement.

Checkbox *

I understand that all students who are registered at Myers are considered to be serious ballet students who are dedicated to the best training possible. I understand that lack of appropriate behavior and attitude is grounds for immediate dismissal from classes and/or the school. Training will be under the watchful eye of Miss Myers and her professional staff. I understand that any additional training elsewhere will be cause for immediate dismissal from the school.

I have read, understood, and agree with the above statement.