Name of person attending workshop/class/party/performance *

First Name

Last Name

Parent/Guardian Name (if under 18)

First Name

Last Name

Date of attendance *

Write the first date of attendance if the workshop/class goes for more than one day

MM

DD

YYYY

Emergency Contact *

(###)

###

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Assumption of Risk: *

I have read and understood the Guidelines and Policies for Bom Funk Dance Studio and hereby agree to adhere to all Guidelines and Policies. I acknowledge that I am liable for all costs incurred against me/my child. This may include additional costs for participation in workshops, competitions, performances or other events. Please enrol me/my child in the classes selected. I understand the nature of the activities I/my child(ren) will be involved in at Bom Funk Dance Studio, the experience and capabilities required, and believe my child(ren)/self to be in good health, and in proper physical condition to participate in such activities.

I have read the "Assumption of Risk" Agreement and agree to the terms.

Medical Emergencies *

In any event of an accident or emergency I hereby authorise my child(ren)/self to be transported to a hospital for medical treatment and I hold Bom Funk Dance Studio and it's representatives harmless in the execution of such. Additionally, I hereby agree to individually provide for all medical expenses which may be incurred by me or my child(ren) as a result of any injury sustained while participating at or for Bom Funk Dance Studio. In the case of my child(ren)/self requiring medical treatment or in the case of a medical emergency, I consent to the school providing first aid or treatment and I further authorise the school, where it is impracticable to communicate with me, to arrange for him/her to receive such medical or surgical treatment as may be deemed necessary. I also undertake to pay any costs which may be incurred for the medical treatment, ambulance transport and drugs. Whilst due care is taken in the selection of dance moves and execution of steps, I am aware that there is always a risk of injury relating to participating in a physical activity.

I have read the "Medical Emergencies" Agreement and agree to the terms.

Photos/Video for Promotion *

Photos and/or video from shows, classes and performances are sometimes used to promote Bom Funk Dance Studio on posters, Bom Funk Facebook pages, Bom Funk website and other media. I permit Bom Funk to photograph and/or film class and event participation for the promotion of the studio and use images of myself/child(ren), for use in the studio, in the media and on the internet. DURING WORKSHOPS - if you do not wish to be filmed or photographed, please let a teacher know or step to the side during a film/photo run.

I have read the "Photo/Videos for Promotion" Agreement and agree to the terms.

Physical Contact *

During tuition an instructor or assistant teacher from the School may make physical contact with the Student, in the following circumstances: (a) In order to provide instruction to the Student when demonstrating exercises or techniques. (b) Where in the reasonable opinion of the Studio, a Student requires any treatment for an injury e.g. bandage or ice pack.

I have read the "Physical Contact" Agreement and agree to the terms.

Studio Policies *

Bom Funk Dance Studio General Guidelines & Policies can be found on http://www.bomfunk.com.au/policies/. Should you have any questions or concerns regarding our policies, please contact Bom Funk before agreeing below. Bom Funk Dance Studio may update Guidelines and Policy Documents at any time. If policies are updated, the student/family must immediately re-accept this waiver or their position at the studio may be revoked.

I agree to the terms of the "Studio Policies" and

Supervision *

Students are only supervised by the staff of the studio during tuition inside the studios. Appropriate drop-off and collection times must be arranged by the guardian/parent before and after tuition. Appropriate drop-off and collection times must be arranged by the guardian/parent before and after tuition. Waiting areas, hallways, bathrooms and carparks are not officially supervised by staff. Whilst all reasonable care is taken, BFDS is not liable for students outside of scheduled classes or the immediate premises. Parents are responsible for supervising their children when not in lessons.

I have read the "Supervision" Agreement and agree to the terms.

Illness Policy *

Illness Policy Colds, flu, and other contagious diseases occur frequently and spread easily among children. To help protect your own child’s health and to minimise the possibility of contagion at school, please keep your child at home if you observe any of the following symptoms: Nasal discharge that is green or yellow Complaints of ear pain Consistent cough Severe sore throat Eyes that are pink, burning, itching, or producing discharge Diarrhoea or vomiting Fever If these symptoms or other conditions deemed contagious are observed in your child during a class, you will be called to pick up your child immediately. When you/r child has a fever, please keep him/her at home until the temperature returns to normal. If there are any lingering signs of illness, such as glassy or watery eyes, listlessness, and drowsiness, please keep your child at home.

I have read the "Illness Policy" Agreement and agree to the terms.