Name of Dancer *

First Name

Last Name

Dancer's Date of Birth *

MM

DD

YYYY

Name of Primary Contact *

First Name

Last Name

Liability Waiver *

I, the parent or legal guardian (now on referred to as Primary Contact) of myself or the child listed in this registration form, realize that participation in dance classes and activities could involve some possible personal injury. Despite precautions, accidents and injuries may occur. By agreeing to this release form, I/we assume all risks related to using any and all spaces used by and programs, activities, rehearsals or shows run by Give Me Brilliance Dance (now on referred to as GMB Dance). I/we agree to release and hold harmless GMB Dance, including its teachers, dancers, staff members, volunteers and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold GMB Dance liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behaviour in addition to any damage I/we may cause to the facilities utilized by GMB Dance. Finally, I/we agree to inform GMB Dance of any physical limitations my child has before starting any programs with GMB Dance and with the understanding that my child's doctor has approved participation in physical activities such as dance.

Agree

Payment Agreement *

I, the Primary Contact of the dancer indicated by name in this registration form, understand that I am taking sole responsibility for any tuition, registration and/or costume fees associated with the classes I have registered my child in. By registering myself or my child, I am committing to any and all associated fees before myself or my child is able to participate in any activity. Should I fail to complete payment of said fees, I understand myself or my child may not be able to participate. I understand that any payment arrangements with other family members, including the other biological parent of said child who is not residing in the same residence as myself, is my sole responsibility to organize. I understand that GMB Dance is unable to invoice anyone other than myself for fees associated with mine or my child's class unless a separate Payment Agreement is signed by any other party taking responsibility for payment, and that Agreement is emailed to support@gmbdancer.com, or appropriate court documents naming both parents responsible for payment can be produced. For families who are in need of a this separate Payment Form please email: support@gmbdancer.com

Agree

Payment Policies *

I, the Primary Contact, agree to GMB Dance's payment and refund policies: 1) All fees must be paid before or on the first class of each session. Payments can be made via e-transfer to support@gmbdancer.com, cash or credit card via a secure link. Please make cheques payable to Give Me Brilliance Dance. 2) Should my child or I wish to cancel enrolment after a session has begun, GMB Dance must be notified via email at support@gmbdancer.com prior to the third class for eligibility of a refund of remaining classes (not applicable to any already taken). 3) GMB Dance reserves the right to cancel any class without sufficient registration. In the event of a class cancellation, students who registered and paid for the class will receive a full refund.

Agree

Image Capture Agreement *

I/we agree to allow GMB to take and use images of students and families of GMB on the GMB website, social media pages, in brochures or other promotional materials. It is understood that no identifying information is ever attached without permission.

Yes

No