Summer Intensive Registration

Student Dancer Name

Address

Email

Parent/Guardian #1

Phone Number

Parent/Guardian #2

Phone Number

Other Emergency Contact

Phone Number

Age

Birthdate

Grade Finished in School

Weeks Planning to Attend

Dance School Attended

How did you hear about the Summer Intensive

Opt-In

At BQCSOD there are many times when the students will be photographed or filmed for various reasons by the local media or staff. Many times we don’t know what photos or clips the media will use. Occasionally we will use photos for our own print needs. Dance training of all kinds usually culminates in a performance, many times for the public. Again, we have no control over the media or anyone in the audience that might have a camera. By checking, I agree to have my child photographed.

Opt-In

By checking, I agree to that I am not aware of any injury or other health related issues that would restrict or limit my child's ability to participate in the Summer Intensive. I agree to assume all risks and expenses due to an injury that may occur as a result of my child's involement in the Summer Intensive. I agree to hold Ballet Quad Cities School of Dance or anyone acting on it's behalf as an instructor or administrator harmless in the event of an injury to my child while participating under the supervision of the above.