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GRDA@HOME Zoom Class Registration
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Student's Name
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Student's Date of Birth
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Parent's Name
*
Parent's Phone Number
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Parent's Email
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Preferred Age Group (select all that apply)
*
3 - 5 years old
6 - 8 years old
9 - 12 years old
13 years old & Up
Adult
(Select all that apply)
Preferred Class
*
Ballet
Jazz & Musical Theatre
Hip Hop
Contemporary
Other
(Select as many as needed)
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I consent to the data entered on this application to be stored on Genevieve Ryan Dance Academy Database.
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I consent to allow Genevieve Ryan Dance Academy to contact me by email, phone, and/or text.
I consent to my child’s photo being published in local newspapers, newsletters, and on the Genevieve Ryan Dance Academy website and social media pages.
Acknowledgement
*
I ACKNOWLEDGE THAT THIS IS A PHYSICAL ACTIVITY AND I SHOULD GET MY DOCTORS PERMISSION IF MY CHILD OR I SUFFER FROM ANY HEALTH PROBLEMS. I AGREE THAT THE INSTRUCTORS ARE NOT RESPONSIBLE FOR ANY INJURIES OBTAINED DURING CLASS HOURS. INSTRUCTORS TAKE NO RESPONSIBILITY FOR LOSS OR DAMAGE TO PERSONAL BELONGINGS. PLEASE INFORM TEACHERS OF ANY ILLNESSES OR INJURIES.
Read above & Agreed Signature:
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Date
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