Your Name (Parent/Guardian's name) *

First Name

Last Name

Phone number *

(###)

###

####

Student's Name *

First Name

Last Name

Birthday *

Please put student's birthdate, to aid in class placement

MM

DD

YYYY

#2 Student's Name

First Name

Last Name

Birthday

Please put student's birthdate, to aid in class placement

MM

DD

YYYY

#3 Student's Name

First Name

Last Name

Birthday

Please put student's birthdate, to aid in class placement

MM

DD

YYYY

COVID Disclaimer *

Due to the COVID-19 pandemic, Radiance School of ballet has been exploring different and reasonable ways to provide services to as many of our students as possible. The school has followed closely with state and local agencies, including our local health department, to draft and implement guidelines moving forward regarding cleaning, screening, social distancing, etc. Though Radiance School of Ballet and its staff will work hard to implement and abide by those guidelines, neither the guidelines themselves nor even guidance from the Centers for Disease Control and Prevention (“CDC”) would allow Radiance School of Ballet to guarantee an environment that is entirely free of COVID-19 related risks. By allowing your child to return to the studio, however, you acknowledge and understand that your child’s attendance will require him/her to physically interact with the school’s staff members and other students. As such, despite reasonable mitigation efforts on behalf of Radiance School of Ballet, physical interaction with the public at large may pose some unavoidable risks to you, your child, and your family due to the COVID-19 pandemic. With that, you further acknowledge and agree to the following: 1. Waiver and Release. You hereby release and forever discharge and hold harmless Radiance School of ballet and its staff from any and all liability, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from your child’s return to the studio and/or participation in activities associated with the school. You understand that this release discharges Radiance School of Ballet from any liability or claim that you may have against the school with respect to the COVID-19. 2. Assumption of Risk. You further understand that your child’s return and/or participation may expose him/her and others to unavoidable COVID-19 community spread. As such, you hereby expressly and specifically assume the risk of injury or other harm, and expressly release Radiance School of Ballet from all liability for injury, illness, or other issue resulting from or in any way related to your child’s return or participation. 3. Adhere to all Radiance School of Ballet Policies and Procedures: You agree that your child will follow all implemented policies and procedures, such as proper mask protocols, washing hands or using supplied hand sanitizer upon entry and exit to and from classrooms, staying 6ft apart at the barres and in our center floor work, knowing teachers will only supply verbal correction, and not coming to studio classes if you are feeling ill or running a fever.

By clicking this box I acknowledge that I have read, understand and agree to Radiance School of Ballet's COVID Disclaimer.

Agreement *

I hereby agree to indemnify and hold Radiance School of Ballet, Anastasis Ballet Company, its teachers and staff from and against any and all liability, any COVID-19 related health issues, injury or property loss sustained by participant or his/her family arising out of or in any way connected with participation in classes offered by Radiance School of Ballet. I hereby execute the agreement waiver and release on behalf of my son/daughter. I state that said minor is physically able to participate in selected activity. I hereby agree to indemnify and hold persons and entities of Radiance School of Ballet and Anastasis free and harmless of any loss, liability and damage that may occur.

I Agree