Saturday, September 25th Workshops

Thriller Dance ~ 11-12:30 pm. No experience required. learn the dance as in Michael Jackson's classic music video! Learning the dance makes you eligible to perform on Halloween on the streets of down town Silverton. $15 per person. Fundraiser for new dance floor!

October Workshops

Saturday, October 9th, 16th, and 23rd 11-12:30 pm

Thriller Dance ~  No experience required. learn the dance as in Michael Jackson's classic music video! Learning the dance makes you eligible to perform on Halloween on the streets of down town Silverton. $15 per person. Fundraiser for new dance floor!

Students Full Name: ____________________________________ Date of Birth _________ Age (as of 9/09)____ ______

Home Phone: ________________________ __Email (required for communication) __________________________________

Address _________________________________________City ___________________ State ______ Zip ____________

Mother/Parent/Guardian #1 _____________________________________Work Phone #_________________________

                                                                                                                                                                Cell Phone # _____________________

Father/Parent/Guardian #2 ______________________________________Work Phone #_________________________

                                                                                                                                                                Cell Phone # _____________________

Emergency contact (if different from parent’s cell phones)

Name ________________________________________________________ Phone # ____________________________

For New Students Only

Previously Trained with __________________________________________ How long? ______________ years

Sample: Class ___Intermediate Ballet________ Day __Tuesday & Thursday__ Time __7:30-8:45 pm

                Class _______________________________Day ___________________________ Time _________________

                Class _______________________________ Day ___________________________ Time _________________

               Class _______________________________ Day ___________________________ Time _________________

Occasionally we like to use student’s photographs from classes or performances in our brochures, flyers, or on the web site. Please sign below if you give us your permission to use your child’s photograph.

I give American Academy of Performing Arts Co. permission to use my daughter/son’s photograph(s) in publications and/or on the website.

Must be signed for student to participate in classes and performances. Please read carefully before signing.

I _______________________________________________, the enrolled participant and/or the parent/guardian of the participant

agree and understand that dance/fitness training is a potentially hazardous activity. I recognize that there are risks inherent in dance

training including, but not limited to, serious physical injury. The participant hereby agrees to participate in activities of the American Academy of Performing Arts Co. of Oregon and hereby agrees to indemnify and hold harmless American Academy of Performing Arts Co, its instructors, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in activities of the American Academy of Performing Arts Co. The participant also agrees to indemnify American Academy of Performing Arts Co. for any damages incurred arising from any claims, demand, action or course of action by the participant. The participant authorizes any representative of American Academy of Performing Arts Co. to have the participant treated in any medical emergency during their participation in activities of the American Academy of Performing Arts Co. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

 Any special medical/health/social problems or needs of which the staff should be aware are outlined here (please include any learning disorders, autism, ADD, ADHD, Asbergers, allergies and previous injuries):_____________________________________________________________________________________________________________________________________________________

I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENT AND

SIGNIFICANCE. ADDITIONALLY, I HAVE READ AND AGREE TO ABIDE BY ALL STUDIO POLICIES AND PROCEDURES.

____________________________________________________________________

Student’s Name (please print)

____________________________________________________________________

Signed Date

____________________________________________________________________

Parent/Guardian (if participant is under 18) (please print)

____________________________________________________________________

Signed Date