Send or bring this form to:
Kidz in Motion Dance Company 635 South Washington St., Papillion, NE. 68046
You can also register by e-mailing Traci at or texting her at 425-890-0957.
Please enclose your $25 non-refundable registration fee and return the form and payment to the studio. There is a $35 fee for returned checks. (Make copies for additional students).
Years of dance experience:
(we will exclusively use your e-mail as our form of communication throughout the year..Confirmations, newsletters, cancellations, etc.
Please list the Dance Class(es)/Camp(s) Registering for:
In consideration of me or my child being permitted to participate in Kidz in Motion Dance Co. programs and activities, the undersigned, appreciating any possible dangers, hazards, or injuries inherent in Kidz in Motion Dance Co. programs and activities, hereby assumes the risks and responsibilities surrounding my or my child's participation in the foregoing programs and activities or other activities as an adjunct hereto; and further, I, for myself, my heirs, and personal representative(s) hereby defend, hold harmless, indemnify, release and forever discharge Kidz in Motion Dance Co. and all its owners, agents, and employees from and against any and all claims, demands, and actions or causes of actions on account of damage to property or personal injury, which may result in my or my child's participation in such programs and activities which result from causes beyond the control of and without gross negligence of Kidz in Motion Dance Co., its owners, agents, and employees during the period of my participation.
I further understand and agree that I give this release freely, voluntarily, and in the consideration of me or my child being granted permission to participate in the Kidz in Motion Dance programs and activities. I also agree that this Release and Liability Waiver shall be effective whether or not I have in force any policy of insurance to cover me or my child for injuries which may arise from participation in Kidz in Motion Dance programs and activities. If I do not have any such policy in effect then I personally assume and agree to pay for the loss or damage occasioned from said activities which result from causes beyond the control of and without gross negligence of Kidz in Motion Dance Co., its owners, agents, or employees during the period of me or my child's participation, and I expressly agree not to look to Kidz in Motion Dance Co. for reimbursement for any such loss or damage.
I do hereby unconditionally release and forever discharge any and all claims, demands, actions, and causes of action whatsoever arising from, or in any manner connected with, or growing out of the use in any manner whatsoever, of the pictures and sound of me taken by Kidz in Motion Dance Co. for internal or external use coverage/production, internal or external media, including but not limited to publications, web site, videos, and presentations.
I understand & agree with all Rules, Policies & Regulations put forth by Kidz in Motion Dance Company.
DANCER(s) Name(s): _________________________________________________________________________________________
SIGNATURE:_________________________________________________ (If under 18 years of age, your parent or guardian must sign.)