Enroll for Youth Classes

Current Students

New Students

Student Name *
Student Name
Parent Name
Parent Name
Student Date of Birth *
Student Date of Birth
Phone Number *
Phone Number
Address *
Address
View Class Schedule Enter one class per line. Examples: Tuesday - Ballet 1 - 3:00 PM Wednesday - Jazz 2 - 6:00 PM
Referral Name
Referral Name
If you were referred by another person, please enter their name.
Liability Waiver *
In consideration of being allowed to participate at any Elements Dance Space class or event, I, for myself, and on behalf of my heirs, assigns, personal representative, and next of kin, the undersigned: 1. Release, waive, discharge, and agree not to file suit against Elements Dance Space , their affiliated clubs, their administrators, directors, agents, coaches, and other employees of the organization, other participants, volunteers, sponsoring agencies, sponsors, advertisers, their heirs, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees", from demands, losses, or damages, on account on injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 2. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability, or death. 3. Authorize and give my full consent to Elements Dance Space to copyright and/or publish any and all photographs, videotapes, and/or film in which I and/or the minor participants appear while attending any Elements Dance Space class or event. I further agree that Elements Dance Space may transfer, use, or cause to be used, these photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, and television programs without limitations or reservations. 4. Certify that I do consent and agree to my release as provided above of the releasees, and for myself, my heirs, assigns, and next of kin, to indemnify and hold harmless the releasees from any and all liabilities incident to my involvement or participation in these events as provided above. I hereby agree that I am signing this registration form with or without my parent/guardian present. This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to my release as assigns, provided above of the releasees, and for myself, my heirs, and next of kin, to indemnify and hold harmless the releasees from any and all liabilities incident to my minor child's involvement or participation in these events as provided above.