January-February Homeschool Ballet Registration — Creative Arts Council of Wells County


January - February Homeschool Ballet Registration
Family Contact Information
Please complete all information.
Father/Guardian Name
Mother/Guardian Name
Address 1
Address 2
City
State/Province
Zip
Primary Phone
Phone Type
Secondary Phone
Phone Type 2
Emergency Contact (not parent)
Emergency contact relation to student(s)
Emergency Contact Phone
Who drives student(s) to class
Parent's Email

Student 1
Student 1 Name
Student 1 Birth Date
Student 1 Current Grade
Student 1 Special Medical/Health Factors
Student 1 T-Shirt Size


Student 2
Student 2 Name
Student 2 Birth Date
Student 2 Current Grade
Student 2 Special Medical/Health Factors
Student 2 T-Shirt Size


Waiver
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen by nature of the physical, athletic activity engaged in while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage. I understand that the art of dance and nature of dance and theater instruction may sometimes require a teacher to touch students. I also understand that this will happen in a respectful, gentle and appropriate manner. I understand, further, that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc. I understand the risks involved by allowing my child to participate in the Creative Arts programming during the COVID-19 pandemic. Because of this, I will not hold responsible the Creative Arts Council of Wells County, its staff, volunteers, board, or instructors if I/my child contracts COVID-19. I understand that I/my child will be expected to participate in procedures used by the Creative Arts Council in order to minimize the transmission of the virus. Such procedures will be implemented by Creative Arts Council staff/instructors and include washing hands, using hand sanitizer, temperature checks, maintaining social distance, etc. Further, I understand students should not attend Creative Arts programs if they have experienced COVID-19 symptoms (coughing, shortness of breath, etc.) within the last 72 hours, had a fever within the last 72 hours, and/or has been exposed to someone with COVID-19 within the last 10 days. I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time. I agree to pay tuition in full at the time of this registration in order for my spot(s) to be held. I understand tuition is non-refundable. By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.
	I agree

*Please note: Registration Fee/Tuition Payment options will be sent out in the email confirmation you receive when you click on the "Register Now" button below.*