Parent Name *

First Name

Last Name

Parent Phone *

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Student's Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Liability Waiver & Risk Acknowledgement *

I acknowledge and assume any and all risks which might occur to me or my child while traveling to and from or participating in an Elise Flagg Academy of Dance, Inc. class, rehearsal, performance, or activity. I also exempt, release, and indemnify the Elise Flagg Academy of Dance, Inc., its owners, agents, employees, volunteers, guest artists, and students from any and all liability claims, demands, or causes of action whatsoever from any damage, injury, or loss to me, my children, or property which may arise out of or in connection with participation in any Elise Flagg Academy of Dance, Inc., class, rehearsal, performance or activity. I further hereby waive my rights and that of my heirs and assigns to hold The Elise Flagg Academy of Dance, Inc. , its owners, agents, employees, volunteers, guest artists, faculty members and students liable for such damage, injury, or loss. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.

I have read the above and agree.

Classes Interested

Pre-Ballet

Classical Ballet

Contemporary

Jazz

Pilates

Dance Company

Summer Session

Interim/Workshops

Private Lessons

Virtual Lessons