| Family Name:*required |
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| Contact First/Last Name:*required |
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| Relationship to Student:*required |
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| Home Phone:*required |
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| Work Phone:*required |
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| Cell Phone:*required |
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| Evening Phone:*required |
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| Email: *required |
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| Street Address: *required |
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| City: *required |
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| State: *required |
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| Zip Code: *required |
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| Health Insurance Carrier: *required |
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| Student's First/Last Name: *required |
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| Student Birthdate (dd/mm/yyyy): *required |
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| Student School Attending: *required |
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| 2008-09 School Grade: *required |
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| Disabilities: *required |
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| Allergies: *required |
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| How Did You Hear About Us: |
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| DanzLevelz Performance Program Kindergarten |
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| DanzLevelz Performance Program Gr 1-2 |
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| DanzLevelz Performance Program Gr 3-4 |
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| DanzLevelz Performance Program Gr 5-6 |
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| Cape All Star Dance Team Grades 4-6 |
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| Cape All Star Dance Team Grades 7-9 |
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| Klub Princess Program Ages 3-4: |
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| Klub Program Kindergarten: |
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| Klub HSM Program Grades 1 & 2: |
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| Queen and I Choice: |
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| Dance N-Play Choice: |
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| Open Class: |
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| Home School Classes: |
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| TheatreKidz: |
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| Yes I Can!: |
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RELEASE OF LIABILITY
As the legal parent or guardian, I release and hold harmless KIDZLINX, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of KIDZLINX its owners and operators or in route to or from any of said premises.
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I've read the statement and agree. *required
PARENT'S NAME PLEASE TYPE IN NAME *required
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| SIGNATURE STATEMENT As the legal parent or guardian, I release and hold harmless KIDZLINX, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of KIDZLINX its owners and operators or in route to or from any of said premises. |
I've read the statement and agree. *required
PARENT'S NAME PLEASE TYPE IN NAME *required
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| Parent Signature: By clicking "SUBMIT" button below, I, the Parent or Guardian of the above student, release KIDZLINX including instructors and assistants, from liability for any and all injuries which the student may sustain while training, rehearsing, or performing or during any event or activity. I agree that I am responsible for health and accident insurance and any medical costs incurred due to injury. I give my permission for emergency medical treatment and transportation at my expense if the need arises. I also give my permission for the public display, in studio, in print advertisements, and on the website, of any KIDZLINX photographs that may include my child. |
I've read the statement and agree. *required
PARENT'S NAME PLEASE TYPE IN NAME *required |
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