Parental Consent Form

STUDENT INFORMATION

Course Name

Student Name and Family name:

Student Date of Birth:

Phone Number:

Address:

How did you hear about us?

Student’s medical condition ( if applicable ) :

Any important medication need to be taken during class :

LIABILITY RELEASE FORM AND ASSUMPTION OF RISK

I/we realize that participation of my kid in dance classes and activities could result in some possible personal injury. Despite precautions being taken by the studio, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by NikAnooheh Dance Inc. I/we agree to release from responsibility the NikAnooheh Dance Inc., including all teachers, dancers, staff members, and facilities used by entity from any cause of action, claims, or demands now and in the future. I/we will not hold NikAnooheh Dance Inc., liable for any personal injury including: scrapes, bruises, cuts, sprains, fractures, broken bones, concussions or death or any personal property damage/loss, which may occur on the premises before, during or after classes.

Initial

Date

Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by NikAnooheh Dance Inc..

Initial

Date

I understand that NikAnooheh Dance Inc. is insured organizations. In the event that I/we should observe any unsafe conduct or conditions before, during or after my kid’s classes, I/we agree to report the unsafe conduct or conditions to Anoheh Booryaee or Nika Shavandi, the owners as soon as possible.

PHOTOGRAPHY/ VIDEO – I give permission for my son/daughter’s photographs/videos to be used for publicity and advertising in the studio, on NikAnooheh Dance Inc. websites social media platforms, and in the community.

Initial

Date

RULES AND REGULATION

- Absolutely NO PARENTS or FRIENDS allowed in class except on designated viewing days or by consulting with the instructor before class.
- Please be ready on time for class meaning: hair, clothing, and shoes are on and ready before class begins.
- Students are required to have fun and not all the class duration dedicated to specific dance moves.
- Please do not enter studios before designated class time out of respect for the class in session.
- Refunds will not be permitted after the second session. After that date we assume students will be continuing with us for the rest of the program. Exceptions for medical emergencies and small children.

Parent/Guardian

Date

PARENTS OR GUARDIAN INFORMATION

Name(s):

Email(s):

Phone number(s):

Emergency Contact Info:

Any preference or details:

(Please read carefully and submit before the first class session)

I/ We have read and agree to comply with these policies.

Parent(s) or Guardian’s Full Name (as a Signature)

Registration Date: