Adult Student Sign Up Email * Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Emergency Contact (Name and Number) Medical Conditions (leave blank if none) How did you hear about us? Internet Friend Other Previous Dance Training: Number of years and most recent training Waiver of Liability * I, the undersigned, understand that I am taking dance classes at my own risk, and neither JL Dance, LLC (d/b/a Ballet Academy of Charleston) nor any instructor or faculty member is liable for any injury sustained during any Ballet Academy of Charleston class or other related activity. I accept all risk for any illness or injury associated with any participation and waive any right to sue and waive any right or claim for damages against JL Dance, LLC and its owner, staff, and faculty. Agree Medical Release/Permission for Treatment I GIVE permission for JL Dance, LLC to seek medical treatment for myself in the case of an injury or serious illness that requires immediate attention. I DO NOT GIVE permission for JL Dance, LLC to seek medical treatment for myself in the case of an injury or serious illness that requires immediate attention. Photo Release I GIVE permission for JL Dance, LLC to use photographs of myself for the purpose of marketing the studio. I DO NOT GIVE permission for JL Dance, LLC to use photographs of myself for the purpose of marketing the studio. Thank you!
