Register Online for Summer 2021 – Dance Academy of Bloomfield Hills

Summer Registration

Student's First Name*

Student's Last Name*

Email Address*

Home Address*

City*

Zip-Code*

Mother's Name*

Father's Name*

Cell Phone*

Work Number

Child’s Date of Birth

DANCE CAMP SCHEDULE

Session I: June 26 - 27 - 28 - 29

Little Explorers of Dance: 10:00am - 1:00pm Ages 5 - 8 Next Level Dancer: 1:00pm - 4:00pm Ages 9 - 12

Session II: July 17 - 18 - 19 - 20

Little Explorers of Dance: 10:00am - 1:00pm Ages 5 - 8 Next Level Dancer: 1:00pm - 4:00pm Ages 9 - 12

Session III: August 1 - 2 - 3 - 4

Little Explorers of Dance: 10:00am - 1:00pm Ages 5 - 8 Next Level Dancer: 1:00pm - 4:00pm Ages 9 - 12

JUNE CLASS SCHEDULE

HIP HOP w/ Mr. Derrick June 21-28 Wednesdays

4:00-5:00 Hip Hop ages 5-8 5:00-6:00 Hip Hop ages 9-12 6:00-7:00 Hip Hop ages 13 & up

June 21-22 W/TH Ms. Nia

June 19, 20 M/TH Ms. Alex

10:00-11:00 Jazz ages 5-8 11:00-12:00 Ballet ages 5-8 12:00-1:00 Ballet/Jazz ages 9-12 1:00-2:00 Creative Movement ages 3-5

Adult Tap

Mondays 2:30 & 7:30 June 5-12-19-26

Adult Jazz

Tuesdays 7:30 June 6-13-20-27

JULY CLASS SCHEDULE

July 3, 5, 10, 12, 17, 19, 24, 26 M/W Ms. Alex

11:00-12:00 Creative Movement ages 3-5 12:00-1:00 Ballet/Jazz ages 5-8 1:00-2:00 Contemporary ages 9-12

July 6, 11, 13, 18, 20, 25, 27 T/TH Ms. Lucy

10:00-11:00 Int Ballet ages 8-12 11:00-12:30 Int/Adv Ballet/Pointe 12+ 12:30-1:30 Ballet/Jazz ages 9-12

July 12, 19, 26 W Mr. Derrick

4:00-5:00 Hip Hop ages 5-8 5:00-6:00 Hip Hop ages 9-12 6:00-7:00 Hip Hop ages 13+

Adult Tap

Mondays 2:30 & 7:30 July 3-10-17-24

Adult Jazz

Tuesday 7:30 July 4-11-18-25

AUGUST CLASS SCHEDULE

August 14, 16, 21, 23 Ms. Alex

10:00-11:00 Ballet/Jazz ages 5-8 11:00-12:00 Creative Movement ages 3-5 12:00-1:00 Ballet/Jazz ages 9-12

DABH Company Intensives August 7 - 8 - 9 - 10

Seniors 9:00am – 12:00pm Intermediates 12:00pm – 3:00pm Juniors 3:00pm – 5:00pm

Adult Tap

Monday 2:30 & 7:30 August 7-14-21--28

Adult Jazz

Wednesday 7:30 August 8-15-22--29

Please Complete Registration Information Below

Type Any Additional Questions You Have Here:

There is a one time $25 registration fee per student... Please call studio and or bring in credit card payment information. Monthy/Session will be processed, at the Studio not online and kept on file.

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<< Check this box for Auto Pay with my credit card - SESSION

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Agreement :*

Agreement - By submitting this registration I have read in its entirety and agree to the DABH studio policies and contract below: By submitting this registration I Release and Agree to Waiver of Injury and agree to full payment with Credit Card on File agreement. I, do hereby voluntarily submit myself for attendance and participation in the Dance Academy of Bloomfield Hills and do hereby assume full responsibility for any and all damages, injuries or losses that she/he may sustain or incur in anyway while attending or participating in any Dance Academy of Bloomfield Hills classes or activities. I do hereby waive all claims against the instructors, the owners and/or operators, individually or otherwise, of the Dance Academy of Bloomfield Hills, for any injuries I may sustain while attending or participating in said programs. I fully understand that any medical treatment given to me will be for first aid only. This form can be photocopied for emergency treatment. For and in consideration of the acceptance of our child/children minor(s) in the programs offered by Dance Academy of Bloomfield Hills ("DABH"), we as parents and guardians of such minor(s), so hereby release and forever discharge DABH, its principals, employees and agents and their heirs, personal representatives, successors and assigns, and save them from harmless from and against any and all claims, actions, liabilities, damages and expenses in connection with loss of life, personal injury and/or damage to or loss of property arising from or out of the participation of such minor(s) in the programs of DABH. By reading and signing and or submitting electronically this legally enforceable Release, I/we acknowledge that I/we have carefully read and fully understand the provisions hereof. PHOTO RELEASE I grant permission to the DABH, to use photographs and or video taken of me or my child for use on DABH web sites or other electronic forms or media, and to offer the photographs for use or distribution without notifying me. I agree that any and all PHOTOS and or VIDEO taken on any DABH property and or DABH events including REHERSALS, COMPETITIONS or RECITALS are the property of the DABH and are not to be used for any purposes unless a written approval to the individual from the DABH. I/WE agree to not SOLICIT any DABH students, parents or guardians for the sale of any PHOTOS or VIDEO without DABH written approval and that any such action will cause the DABH harm to its brand and business. If any such breach of any such use, I/WE agree that any legal costs for the DABH to enforce its PHOTO RELEASE POLICY are not responsibility of the DABH but are the responsibility and billable to I/WE as the parents and or guardians of the student and is part of this contract to participate in any of the DABH classes and programs. I/WE agree not to post on any POST on any INTERNET WEBSITES or SOCIAL MEDIA and not to RE-PRODUCE any photos or video without the DABH written approval. I hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs and or video. I hereby agree to release and hold harmless DABH, via electronic or media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any re-use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in production of the finished product. I have read this release before submitting this online form, and I fully understand the contents, meaning and impact of this release. CREDIT CARD on File. I agree to pay any and all balances I/we owe the DABH on a monthly or by the session with my Credit Card on file or the Credit Card information contained in this submission to the DABH. I agree to update our Credit Card information as needed to ensure payment is completed when due. I understand a late fee of $25 on any balances no matter the balance amount will automatically be added to my total balance and an interest rate of 1.5% per month for each monthly balance that is outstanding until payment in full is submitted to the DABH. By submitting this registration electronically, I agree and I authorize the DABH to process my total balance on or prior to the end of the year recital. Submitting this form states that you read and agree with the COVID-19 Waiver available on our Homepage