Dance History(Required)
Please list any prior dance instruction or Training. Studio / Style of Dance / Length of Time
Additional Comments
Please list any additional comments, concerns or suggestions below.
Health Issues(Required)
Do you suffer from allergies, asthma, epilepsy, or any other disability, including sports injuries, which you feel the staff should know about? If so, please detail here.
Liability Waiver for *(Required)
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I understand that Arabesque World Dance LLC and Safiya Nawaar Middle Eastern Dance Company are not responsible for any injuries sustained prior to, during, or following any class or dance related activity. Additionally, I recognize that physical participation may expose a student to the risk of injury or harm, and I accept this risk and hereby release Arabesque World Dance LLC and Safiya Nawaar Middle Eastern Dance company, its directors, agents, and employees (herein referred to as ‘Releasees’) from all liability for personal injury, illness, or property damage occuring during instruction or performance. I also understand that the studio/school where the classes take place will likewise not be held accountable for any injury, illness, or property loss or damage occuring during instruction or performance. I certify that “I”, or the “minor participant” I am signing for as a Parent or Legal Guardian, is in good health and fully capable of participating in all of the activities and classes. On behalf of the participant and individually, the undersigned parent(s) and/or legal guardian(s) for the minor participant executes this Waiver. If despite this release, the participant makes a claim against any of the Releasees, the parent(s) and/or legal guardian(s) will reinburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless. I fully understand that the use of alcohol, tobaccos, illegal drugs and/or demonstration of unacceptable standards of behavior will result in dismissal of said student from the studio with no tuition refund.
Photo/Video Release for *(Required)
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I give Arabesque World Dance and Safiya Nawaar Middle Eastern Dance Company the absolute right and permission to use a photograph(s) and or video(s) of me in their promotional materials and publicity efforts. I understand that the photographs may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet/WWW), or other form of promotion. I release Arabesque World Dance and Safiya Nawaar Middle Eastern Dance Company, the photographer, the videographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I am 18 years of age or older.
