Gallery | SSB Dance Center

Step 1: Student Information

Step 1: Student Information

First Name

Last Name

Birthdate

Age

School Attending

Grade for the Upcoming School Year

Step 2: Dance Experience

Step 2: Dance Experience

Years of Dance at SSB Dance Center

Previous Dance Experience or Styles Studied

Step 3: Parent or Guardian Information

Step 3: Parent or Guardian Information

Parent or Guardian First Name

Parent or Guardian Last Name

Relationship to Student

Cell Phone Number

Email Address

Street Address

Apartment or Unit Number

State

ZIP Code

I am registering as an adult student and am completing this form on my own behalf.

Step 4: Apparel Information

Step 4: Apparel Information

Free Text

Please select the size most likely to fit at the beginning of the dance season. SSB Dance Center cannot guarantee exchanges after apparel has been ordered.

T-Shirt Size

Bike Short Size

Step 5: Emergency and Medical Information

Step 5: Emergency and Medical Information

Emergency Contact Name

Relationship to Student

Emergency Contact Phone Number

Allergies, Medical Conditions, Physical Limitations, or Medications

Step 6: Parent Consent and Waiver

Parent or Guardian Consent

I confirm that I am the student’s parent or legal guardian, or that I am an adult student registering on my own behalf. I authorize the student named in this registration to participate in classes, rehearsals, performances, camps, and other activities conducted by SSB Dance Center.

Assumption of Risk

I understand that dance instruction and related physical activities involve inherent risks, including falls, collisions, muscle strains, sprains, fractures, and other injuries. I voluntarily accept and assume the risks associated with participation.

Emergency Medical Authorization

If an accident, injury, or medical emergency occurs and I cannot be reached promptly, I authorize SSB Dance Center and its owners, employees, instructors, and representatives to obtain emergency medical care for the student.

I understand that reasonable efforts will be made to contact me or the emergency contact listed on this form whenever practical. I accept financial responsibility for any medical care, treatment, or transportation provided.

Release of Liability

To the fullest extent permitted by applicable law, I release and hold harmless SSB Dance Center and its owners, employees, instructors, independent contractors, volunteers, and representatives from claims arising from the student’s participation in Studio activities, except to the extent caused by gross negligence or willful misconduct.

Parent and Student Responsibilities

I agree to:

Notify SSB Dance Center of any condition that may affect the student’s participation.
Keep all contact and emergency information current.
Ensure the student follows Studio rules and instructor directions.
Provide appropriate dance attire and footwear.
Pay all applicable registration, tuition, costume, apparel, recital, and related charges according to Studio policies.

Free Text

Parent or Guardian Consent

I confirm that I am the student’s parent or legal guardian, or that I am an adult student registering on my own behalf. I authorize the student named in this registration to participate in classes, rehearsals, performances, camps, and other activities conducted by SSB Dance Center.

Assumption of Risk

I understand that dance instruction and related physical activities involve inherent risks, including falls, collisions, muscle strains, sprains, fractures, and other injuries. I voluntarily accept and assume the risks associated with participation.

Emergency Medical Authorization

If an accident, injury, or medical emergency occurs and I cannot be reached promptly, I authorize SSB Dance Center and its owners, employees, instructors, and representatives to obtain emergency medical care for the student.

I understand that reasonable efforts will be made to contact me or the emergency contact listed on this form whenever practical. I accept financial responsibility for any medical care, treatment, or transportation provided.

Release of Liability

To the fullest extent permitted by applicable law, I release and hold harmless SSB Dance Center and its owners, employees, instructors, independent contractors, volunteers, and representatives from claims arising from the student’s participation in Studio activities, except to the extent caused by gross negligence or willful misconduct.

Parent and Student Responsibilities

I agree to:

Notify SSB Dance Center of any condition that may affect the student’s participation.
Keep all contact and emergency information current.
Ensure the student follows Studio rules and instructor directions.
Provide appropriate dance attire and footwear.
Pay all applicable registration, tuition, costume, apparel, recital, and related charges according to Studio policies.

Required Acceptance

I certify that I have read, understand, and voluntarily agree to the Parent Consent, Assumption of Risk, Emergency Medical Authorization, Release of Liability, and Parent and Student Responsibilities stated above.

Electronic Signature

Electronic Signature

Parent, Guardian, or Adult Student Full Legal Name

Date Signed

By signing electronically, I acknowledge that my electronic signature has the same force and effect as a handwritten signature.

By signing electronically, I acknowledge that my electronic signature has the same force and effect as a handwritten signature.

Optional Photography and Media Consent

Optional Photography and Media Consent

Photography and Media Authorization

Photography and Media Authorization

SSB Dance Center may photograph or record students during classes, rehearsals, recitals, and Studio events. Approved images and recordings may be used on the Studio website, social media pages, advertisements, printed materials, and other promotional communications.

Select one:

Yes, I authorize SSB Dance Center to photograph or record the student and use the material for promotional purposes.

No, I do not authorize promotional photography or recording of the student.

Do not make “Yes” a condition of enrollment.

By submitting this registration, you confirm that the information provided is accurate and complete.

Student Registration

Student Registration Form