New Student Registration

NEW STUDENT REGISTRATION FORM

* Indicates required field

Students Name *

First

Last

Gender *

Students Birthdate *

Parent/Guardian Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Health conditions or allergies? *

Other parent or guardians information that you wish to have on file, please list here. *

JNP Dance Academy Waiver *

I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group dance and other physical exercise sessions, programs or activities conducted at JNP Dance Academy may involve dance, tumbling, fitness, as well as the use of exercise equipment, amenities and facilities owned and/or operated by JNP Dance Academy, its representatives or its contractors. I, as the parent/guardian of the above-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY JNP Dance Academy, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise. I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS. I understand that participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation In the event of accident or emergency, I hereby authorize JNP Dance Academy to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold JNP Dance Academy and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities I understand that my child or ward’s participation in the Activities at JNP Dance Academy may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that JNP Dance Academy retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use.

Confirmation: I, as the parent or guardian of the above-named Minor Participant, certify that I have carefully read the foregoing Liability Release Agreement and by typing my signature below, including any signature affixed in electronic format, consent to be bound by its terms. If I am not the parent or guardian of the below-named Minor Participant, by typing my signature below, I nevertheless agree to all of the terms and obligations in this Liability Release Agreement, as though I was the parent or guardian of the Minor Participant. *

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Thank you for registering your child at JNP and we look forward to dancing with you!