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Dance Program Registration
iAlign Registration Form 2022-2023 Season
2021-2022 Registration form. Complete the form in its entirety. If you have more than 4 children, please fill out another form.
Please enable JavaScript in your browser to complete this form.
-
Step
1
of 3
Adult Name (18 & UP)
*
First
Last
Adult Dancer or Parent/Guardian Name
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
Phone
*
Which iAlign location will you be joining?
*
Select One
Greensboro
Raleigh
Are you a returning student from the 2021-2022 Dance Season?
*
Yes
No
Has Scholarship Assistance been received prior?
*
Yes
No
Is Tuition Scholarship Assistance Needed?
*
Yes
No
Verification Information will be required.
Next
Dancer Sign-Up
Dancer Name #1
*
If an Adult signing up, please fill out Dancer #1 and add your student as Dancer #2.
Dance Program Selection
*
Select One
Community Youth - $ 40.00
Affiliate Youth - $ 55.00
Community Adult - $ 60.00
Affiliate Adult - $ 75.00
Principal Dancer - $ 95.00
Date Of Birth
*
School Name & Grade (IF ADULT, PLEASE SKIP)
Dance Experience
*
Select One
Beginner
Intermediate
Advanced
Are you signing up another dancer?
*
Select One
Yes
No
Dancer Name #2
*
Dance Program Selection
*
Select One
Community Youth - $ 40.00
Affiliate Youth - $ 55.00
Community Adult - $ 60.00
Affiliate Adult - $ 75.00
Principal Dancer - $ 95.00
Date of Birth
*
School Name & Grade
Dance Experience
*
Select One
Beginner
Intermediate
Advanced
Are you signing up another dancer?
*
Select One
Yes
No
Dancer Name #3
*
Dance Program Selection
*
Select One
Community Youth - $ 40.00
Affiliate Youth - $ 55.00
Community Adult - $ 60.00
Affiliate Adult - $ 75.00
Principal Dancer - $ 95.00
Date of Birth
*
School Name & Grade
Dance Experience
*
Select One
Beginner
Intermediate
Advanced
Are you signing up another dancer?
*
Select One
Yes
No
Dancer Name #4
*
Dance Program Selection
*
Select One
Community Youth - $ 40.00
Affiliate Youth - $ 55.00
Community Adult - $ 60.00
Affiliate Adult - $ 75.00
Principal Dancer - $ 95.00
Date of Birth
*
School Name & Grade
Dance Experience
*
Select One
Beginner
Intermediate
Advanced
Next
Waiver and Release of Liability
*
I have read and agree to the Waiver and Release of Liability (listed below)
Please read the Waiver and Release of Liability carefully before joining the class.
In consideration of the risk of injury while participating in iAlign Dance Company (hereafter referred to as the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge, the Activity, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.
I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY
ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL
INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING
PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM, AND DURING THIS ACTIVITY.
I agree to indemnify and hold harmless against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If incurs any of these types of expenses, I agree to reimburse.
I acknowledge that and their directors, officers, volunteers, representatives, and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of.
I acknowledge that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic, and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event.
I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AND ALL OF ITS AFFILIATES, MANAGERS,
MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS
AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FOR PERSONAL INJURY OR PROPERTY DAMAGE.
To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of, its agents, and employees.
In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.
In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.
Signature
*
Clear Signature
Total
$ 0.00
Stripe Credit Card
*
Card
Name on Card
Website
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