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GBAD Registration Form 2012


Waiver of Liability

Great Bay Academy of Dance is not responsible for belongings left in the studio. Students dance at their own risk. We cannot be held liable for any injuries incurred to students and/or parents during classes or while on school premises. I agree that I will not hold Great Bay Academy of Dance, its owners, agents, and. or employees liable for any of the above circumstances.


Student Information


Student Name:

Address:

City:

State:

Zip/Postal:


Phone:

Birth Date:

Student Age as of Sept 1, 2011:

Student Email:

Parent Information


Parent Name:

Day Phone:

Cell Phone:

Parent Email:

Parent Employer #1:

Parent Employer #2:


Emergency Contact Information


Name:

Phone:

Name:

Phone:


Please Indicate Class Choices:


Schedule and faculty subject to change

Please list any medical conditions (injuries, allergies, etc.) that we should know:


I agree to have my student be photographed or videotaped for the press or GBAD promotions ONLY.

I agree to release and hold harmless GBAD, LLC including all of its teachers, staff, dancers and facilities from any cause of actions, claims, or demands now and in the future. I will not hold GBAD liable for any personal injury or personal property damage.

I have agreed to the terms, rules and all policies in the GBAD Student/Parent Handbook.

I understand that GBAD is a licensed and fully insured organization.